【摘要】 目的探讨风湿性多肌痛的临床和骨骼肌病理改变特点。方法13例老年和老年前期患者符合1979年Bird的风湿性多肌痛诊断标准,发病年龄49～78岁,平均60．3岁,主要临床表现为急性发病的四肢近端骨骼肌对称性持续性疼痛。其中5例伴3℃～38℃的低热,1例有轻微贫血,未发现颞浅动脉炎的改变。13例血沉均增快,其中10例血沉大于50 mm/1 h,8例C反应蛋白升高,1例正常,4例未查；9例行肌酶检查,其中2例轻度升高；7例行肌电图检查,2例可见肌源性损害,5例正常。对患者的肱二头肌进行活检,标本进行组织学染色和酶组织化学染色。结果13例患者均有Ⅱ型肌纤维的萎缩,8例肌纤维氧化酶活性出现虫蚀样改变,8例出现肌纤维内脂肪滴增多,3例可见个别不典型破碎样红肌纤维,2例小血管周围可见少量炎细胞浸润。患者经过激素治疗后症状迅速改善,血沉及C反应蛋白显著下降。结论本组患者的主要临床特点是出现对称性骨骼肌疼痛和血沉加快,多数患者存在C反应蛋白升高,而贫血和颞浅动脉炎发生率不高。骨骼肌常见病理改变为Ⅱ型肌纤维萎缩和虫蚀样氧化酶活性改变,肌纤维内脂肪滴增多和部分患者出现破碎样红肌纤维提示此病常伴随能量代谢异常。更多还原

【Abstract】 Objective To study the pathological characteristics of skeletal muscle in patients with polymyalgia rheumatica(PMR).Methods Thirteen patients were diagnosed PMR according to the diagnostic criteria described by Bird in 1979.The onset of disease was between 49-78 years of age (median 60.3 years).All of them showed continuous symmetric myalgia with markedly elevated erythrocyte sedimentation rate(ESR).Five patients had mild fever and 8 patients had elevated C-reactive protein(CRP).Electromyogram(EMG)showed myogenic pattern in 2 patients.Only 1 patient showed anemia and 2 patients had mild elevated creatinine phosphokinase.None of them showed evidence of temporal arteritis.Biceps brachii muscle biopsies were performed in all patients before corticosteroid therapy.Results The typeⅡmuscle fiber atrophy was observed in all patients.Moth-eaten changes appeared in 8 cases,increased intramuscular lipid drops in 8 cases and ragged red fibers(RRF)in 3 cases of them.After steroid therapy,all patients showed improvement of myalgia and normal ESR as well as CRP.Conclusions The main symptoms of the patients are myalgia and abnormal ESR.Some patients have high level of CRP and abnormal EMG.Anemia and temporal arteritis are less frequent.The main myopathological changes were typeⅡmuscle fiber atrophy.Some patients have moth-eaten changes.More lipid drops and RRF indicate abnormal metabolism of skeletal muscle.更多还原