上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (4): 451-.doi: 10.3969/j.issn.1674-8115.2011.04.015

• 论著（临床研究） • 上一篇    下一篇

多发性肌炎和皮肌炎的肾脏损害分析

钱 莹, 任 红, 陈晓农, 张 文, 李 晓, 史 浩, 陈 楠   

  1. 上海交通大学 医学院附属瑞金医院肾脏科, 上海 200025
  • 出版日期:2011-04-28 发布日期:2011-04-28
  • 通讯作者: 陈 楠, 电子信箱: Chen-nan@medmail.com.cn。
  • 作者简介:钱 莹（1969—）, 女, 副主任医师, 博士；电子信箱: huangqw_6869@yahoo.com.cn。
  • 基金资助:

    上海市科委科研计划项目（08dz1900502）和上海市科委重点项目（07JC14037）

Renal injury in patients with polymyositis and dermatomyositis

QIAN Ying, REN Hong, CHEN Xiao-nong, ZHANG Wen, LI Xiao, SHI Hao, CHEN Nan   

  1. Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2011-04-28 Published:2011-04-28
  • Supported by:

    Shanghai Science and Technology Committee Foundation, 08dz1900502, 07JC14037

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摘要：

目的 探讨多发性肌炎与皮肌炎合并肾脏损害的临床特点。方法 收集2003年1月—2008年12月确诊为多发性肌炎和皮肌炎患者的临床资料，回顾性分析肾脏损害的发生率、损害程度和临床预后。结果 在确诊的146例多发性肌炎和皮肌炎患者中，107例（73.29%）首诊于皮肤科，仅4例（2.74%）首诊于肾脏科；共30例患者出现不同程度的肾脏损害，发生率为20.5%。肾脏损害表现为单纯血尿者10例（33.33%），单纯蛋白尿6例（20.00%），蛋白尿合并血尿13例（43.33%），高血压7例（23.33%），水肿3例。10例单纯血尿患者中，镜下血尿>+++者7例；11例接受24 h尿蛋白定量检测患者中，尿蛋白<1 g/d者7例；4例首诊于肾脏科的患者均接受肾穿刺活组织检查，发现局灶节段性肾小球硬化2例，肾小球轻微病变和狼疮性肾炎各1例。所有患者均给予免疫抑制剂治疗。痊愈1例，病情好转或无恶化23例，治疗有效率为80.00%；5例患者死亡（4例并发多脏器功能衰竭，1例合并肺癌），病死率16.67%。结论 多发性肌炎和皮肌炎患者发生肾脏损害并非罕见，临床表现为较明显的镜下血尿、少量蛋白尿和轻、中度高血压以及轻度肾功能异常；患者对免疫抑制剂治疗的反应良好。

关键词: 多发性肌炎, 皮肌炎, 慢性肾脏病

Abstract:

Objective To investigate the clinical features of renal involvement in patients with polymyositis and dermatomyositis. Methods The clinical data of patients with polymyositis and dermatomyositis confirmed from January 2003 to December 2008 were collected, and the incidence, severity and prognosis of renal injury were retrospectively analysed. Results Of the 146 patients confirmed with polymyositis and dermatomyositis, 107(73.29%) visited Department of Dermatology first, while only 4(2.74%) visited Department of Nephrology first. Thirty patients (20.5%) were found to suffer from various degrees of renal injury, which were characterized by single haematuria in 10 patients (33.33%), single proteinuria in 6 patients (20.00%), proteinuria complicated with haematuria in 13 patients (43.33%), hypertension in 7 patients (23.33%) and edema in 3 patients. In 10 patients with single haematuria, 7 had microscopic haematuria >+++. In 11 patients undergoing 24 h urinary protein measurement, 7 had urinary protein <1 g/d. Renal biopsy was performed in all the 4 patients who visited Department of Nephrology first, and it was revealed that two patients had segmental glomerulosclerosis, 1 patient had glomerular minor lesion, and the other patient had lupus nephritis. All patients were treated with immunosuppressant. One patient was cured, 23 patients did not deteriorate or got better, and the effective rate was 80.00%. Five patients died (multiple organ failure in 4 patients and lung cancer in 1 patient), and the mortality rate was 16.67%. Conclusion Renal injury in patients with polymyositis and dermatomyositis is rare, which is characterized by obvious microscopic haematuria, small amount of proteinuria, mild to moderate hypertension and mild renal function disorder, and patients may have favorable response to immunosuppressant.

Key words: polymyositis, dermatomyositis, chronic kidney disease