多发性肌炎患者激素抵抗的影响因素分析
|
摘要
目的:探讨多发性肌炎患者激素治疗抵抗的影响因素。
方法:选择福建医科大学附属第一医院2002.6-2009.11住院的符合B/P诊断标准的多发性肌炎患者93例,参考2005年顾越英的定义:激素大剂量(>1~2mg/kg.d)1个月,仍不能改善症状和使肌酶正常化者,称为激素抵抗,反之为激素敏感,对该93例患者进一步筛选,未治疗或疗程不足,激素量未达上述标准,1个月未复查肌酶者均予排除。结果:激素敏感组20例,男性9例,女性11例,平均年龄39岁;抵抗组39例,男性11例,女性28例,平均年龄44岁,排除34例。研究因素为临床表现和相关实验室检查,共9项,包括:性别、发病年龄、咽喉肌受累、肌力轻重、心脏累及、肝脾淋巴结肿大、伴发肿瘤、伴发结缔组织病、血清肌酸激酶,通过调查病历及随访获得,按统一的标准,填写到统一的调查表中,并采用SPSS(11.0)统计软件,单因素分析采用卡方检验、秩和检验,多因素分析采用Logistic回归分析。除此9项因素外,并调查患者的胸部影像学检查、自身抗体谱、血清免疫球蛋白、甲状腺功能、肌电图检查等情况。
结果:单因素分析:血清肌酸激酶,p=0.000;肌力,OR=3.882,p=0.022;而性别、发病年龄、咽喉肌受累、肝脾淋巴结肿大、心脏累及、伴发肿瘤、伴发结缔组织病等因素未见统计学意义。多因素分析:血清肌酸激酶升高为独立危险因素。另外发现有4例肌电图提示肌强直者均为激素抵抗患者。
结论:1、血清肌酸激酶增高为多发性肌炎患者激素治疗抵抗的独立危险因素,有待进一步验证。2、性别、发病年龄、心脏累及、肝脾淋巴结肿大、伴发肿瘤、伴发结缔组织病等本研究尚不能明确其为激素治疗抵抗的危险因素。3、肌电图提示肌强直者可能为激素抵抗的危险因素,值得进一步研究。
Objective : To investigate the influence factors of treatment that refractory to corticosteroids in polymyositis.
Methods:93 in-patients with polymyositis were investigated from Jun 2002 to November 2009 in First Affiliated Hospital of Fujian Medical University. Following Gu’s definition in 2005:When treated with corticosteroids dose>1 ~ 2mg/kg.d for one month,the symtoms still can not be improved or creatine kinase is still abnormal, it is called steroids-resistance, whereas the steroids-sensitivity.Patients without adequate treatment, or without reviews of CK one month later were exclued.Dived them into two groups,20 patients with steroids-senstive and 39 with steroids-restistent,33 patients were exclued.Clinical and laboratory data were collected ,including Sex, age, throat muscle involvement, muscle weight, heart involved, hepatosplenomegaly and lymphadenopathy, associated with cancer, associated with connective tissue disease, elevated serum creatine kinase .The data was analyzed by SPSS software,respectively by mono-factor analysis and Logistic regression test. The data of chest radiographic findings, autoantibody spectrum, immune serum globulin, thyroid function, EMG, were also collected.
Results: mono-factor analysis:CK,p=0.000;musle strength, OR=3.88,p=0.022; There were no differences in sex, age, throat muscle involvement, heart involved, hepatosplenomegaly and lymphadenopathy,associated with cancer and connective tissue disease by statistics. Logistic regression test:Elevated CK is an independent risk factor.In addition, Four patients with Myotonia in EMG all refractory to corticosteroids.
Conclusions:1.CK evaluate is one independent risk factor of refractory to corticosteroids with polymyositis,should be confirmed.2. Sex, age, throat muscle involvement, heart involved, associated with cancer, associated with connective tissue disease cannot be defined as a risk factor in this study.3. Myotonia in EMG may be a risk factor of refracting to corticosteroids.
方法:选择福建医科大学附属第一医院2002.6-2009.11住院的符合B/P诊断标准的多发性肌炎患者93例,参考2005年顾越英的定义:激素大剂量(>1~2mg/kg.d)1个月,仍不能改善症状和使肌酶正常化者,称为激素抵抗,反之为激素敏感,对该93例患者进一步筛选,未治疗或疗程不足,激素量未达上述标准,1个月未复查肌酶者均予排除。结果:激素敏感组20例,男性9例,女性11例,平均年龄39岁;抵抗组39例,男性11例,女性28例,平均年龄44岁,排除34例。研究因素为临床表现和相关实验室检查,共9项,包括:性别、发病年龄、咽喉肌受累、肌力轻重、心脏累及、肝脾淋巴结肿大、伴发肿瘤、伴发结缔组织病、血清肌酸激酶,通过调查病历及随访获得,按统一的标准,填写到统一的调查表中,并采用SPSS(11.0)统计软件,单因素分析采用卡方检验、秩和检验,多因素分析采用Logistic回归分析。除此9项因素外,并调查患者的胸部影像学检查、自身抗体谱、血清免疫球蛋白、甲状腺功能、肌电图检查等情况。
结果:单因素分析:血清肌酸激酶,p=0.000;肌力,OR=3.882,p=0.022;而性别、发病年龄、咽喉肌受累、肝脾淋巴结肿大、心脏累及、伴发肿瘤、伴发结缔组织病等因素未见统计学意义。多因素分析:血清肌酸激酶升高为独立危险因素。另外发现有4例肌电图提示肌强直者均为激素抵抗患者。
结论:1、血清肌酸激酶增高为多发性肌炎患者激素治疗抵抗的独立危险因素,有待进一步验证。2、性别、发病年龄、心脏累及、肝脾淋巴结肿大、伴发肿瘤、伴发结缔组织病等本研究尚不能明确其为激素治疗抵抗的危险因素。3、肌电图提示肌强直者可能为激素抵抗的危险因素,值得进一步研究。
Objective : To investigate the influence factors of treatment that refractory to corticosteroids in polymyositis.
Methods:93 in-patients with polymyositis were investigated from Jun 2002 to November 2009 in First Affiliated Hospital of Fujian Medical University. Following Gu’s definition in 2005:When treated with corticosteroids dose>1 ~ 2mg/kg.d for one month,the symtoms still can not be improved or creatine kinase is still abnormal, it is called steroids-resistance, whereas the steroids-sensitivity.Patients without adequate treatment, or without reviews of CK one month later were exclued.Dived them into two groups,20 patients with steroids-senstive and 39 with steroids-restistent,33 patients were exclued.Clinical and laboratory data were collected ,including Sex, age, throat muscle involvement, muscle weight, heart involved, hepatosplenomegaly and lymphadenopathy, associated with cancer, associated with connective tissue disease, elevated serum creatine kinase .The data was analyzed by SPSS software,respectively by mono-factor analysis and Logistic regression test. The data of chest radiographic findings, autoantibody spectrum, immune serum globulin, thyroid function, EMG, were also collected.
Results: mono-factor analysis:CK,p=0.000;musle strength, OR=3.88,p=0.022; There were no differences in sex, age, throat muscle involvement, heart involved, hepatosplenomegaly and lymphadenopathy,associated with cancer and connective tissue disease by statistics. Logistic regression test:Elevated CK is an independent risk factor.In addition, Four patients with Myotonia in EMG all refractory to corticosteroids.
Conclusions:1.CK evaluate is one independent risk factor of refractory to corticosteroids with polymyositis,should be confirmed.2. Sex, age, throat muscle involvement, heart involved, associated with cancer, associated with connective tissue disease cannot be defined as a risk factor in this study.3. Myotonia in EMG may be a risk factor of refracting to corticosteroids.
引文
[1]王国春.多发性肌炎和皮肌炎的诊治进展[J].临床内科杂志,2007,24(7):442-445
[2]Douche-Aourik F,Berlier W,Feasson L,et a1.Detection of enterovirus in human skeletal muscle from patients with chronic inflammatory muscle disease or fibromyalgia and healthy subjects.J Med Virol,2003,71(4):540—547
[3] Mastaglia FL, Zilko PJ. Inflammatory myopathies: how to treat the difficult cases. J Clin Neurosci 2003;10:99–101.
[4]Bohan A,Peter JB.Polymyositis and Dermatomyositis.N Engl J Med,1975,292:344-734,403-407.
[5]王吉耀主编.内科学[M].第1版.北京:人民卫生出版,2005:1100-1105
[6]Maugars YM,Berthelot J-MM,Abbas AA,et al. Prognosis of 69 patients with dermatomyositis or polymyositis.Clin Exp Rheum.1996,14:263
[7]阎乎玲.皮肌炎患者心脏损害185例临床分析[J].中国皮肤性病学杂志,2006,9:542-543
[8]佟胜全.多发性肌炎或皮肌炎心脏损害的临床分析[J].中华风湿病学杂志,2005,10,605-608
[9]刘芳,蒲传强.多发性肌炎合并心肌损害的临床特点[J].临床神经病学杂志,2005,18,97-99
[10] Fathi,Maryama;Lundberg,IngIjd Eb.Interstitial lung disease in polymyositis and dermatomyositis.Curr Opin Rheumatol,Volume 1 7(6).November 2005,701-706.
[11]吴大玮.多发性肌炎/皮肌炎相关肺间质病变[J].山东医药.2007,47(32):148-149
[12]帅茂圣,刘元梁.系统性红斑狼疮与皮肌炎重叠综合征1例[J].中国麻风皮肤病杂志,2008,24(8),588
[13]Yves Troyanov.Novel Classification of Idiopathic Inflammatory Myopathies Based on Overlap Syndrome Features and Autoantibodies :Analysis of 100 French Canadian Patients. Medicine 2005;84:231–249
[14]Dalakas MC, Hohlfeld R. Polymyositis and dermatomyositis. Lancet 2003;362:971-82
[15]Yiannis loannou,Myositis overlap syndromes.Current Opinion in Rheumatology 1999,11:468-474
[16]BuchbinderR,Hill C L.Malignancy in patients with inflammatory myopathy.CurrRheumatol Rep,2002,4(5):415-426.
[17]Airio A,Kautiainen H,Hakala M.Prognosis and mortality of polymyositis and dermatomyositis patients.Clin Rheumatol,2006,25(2):234-239
[18]甄莉.皮肌炎合并心脏异常危险因素的研究[J].实用预防医学,2006,2(13),44-46
[19]Toshinori TAKADA.Clinical Features of Polymyositis/Dermatomyositis with Steroid-Resistant Interstitial Lung Disease.Internal Medicine 1998,37:669-673
[20]EDWARD J.FUDMAN.Dermatomyositis without Creatine Kinase Elevation A Poor Prognostic Sign.The American Journal of Medicine 1986,329-332
[21]BRAHIM TABARKI.Childhood dermatomyositis:Clinical course of 36 patients treated with low doses of corticosteroids.European Journal of Paediatric Neurology 1998;2:205-211
[22]Sparsa A,Liozon E,Herrmann F,et a1.Routine vs extensive malignancy search for aduh dennatomyositis and polymyositis:a study of 40 patients.Arch Dennatol,2002,138(7):885-890.
[23]戴冽.甲状腺功能减退性多发性肌炎样综合征57例回顾分析[J].中华风湿病学杂志2007,12,738-741
[24]Milanov L,Ishpekova B.Differential diagnosis of chronic idiopathic polymyositis and neuromyositis.Electromyogr Clin Neurophysio1.1998;38(3):183-187
[25]宋玉强,沈定国.多发性肌炎和皮肌炎患者的临床和肌电图分析[J].临床神经电生理学杂志,2002,11,217-219
[26]崔丽英.皮肌炎和多发性肌炎175例神经传导检测[J].中华神经科杂志,2009,42,608-610
[27]实用神经病学,史玉全,1992,第二版
[28]Coppo P,Clauvel JP,Bengoufa D,et a1.Inflammatory myositis associated with anti-Ul-small nuclear ribonucleoprotein antibodies:a subset of myosltis associated with a favourable outcome.Rheumatology (Oxford),2002,41(9) 1040-1046.
[29]van der Meulen MF,Bronner IM,Hoogendijk JE.Polymyositis an overdiagnosed entity.Neurology,2003,316-321.
[30]Hoogendijk J,Amato A,Lecky B,et a1.119th ENMC international workshop:thedesign in adult idiopathic inflam matory myopathies,with exception of inclusion body myositis,Neummuscul Disord ,2004,14:337-345.
[31]Tabarki B, Ponsot G, Prieur AM, Tardieu M. Childhood dermatomyositis: clinical course of 36 patients treated with low doses of corticosteroids. Eur J Pediatr Neurol 1998,2:205–211
[32]Oddis CV.Current management of polymyositis and dermatomyositis,Drugs,1989,37(3):382-90
[33]Maria Giovanna danieli,et al.intravenous immunoglobulin as add on treatment with mycophenolate mofetil in severe myositis.Autoimmunity Reviews,2009
[34]Steven R,Treatment of Refractory Polymyositis and Dermatomyositis.Current Rheumatology Reports,2006,8:167-173
[1]Maria Giovanna danieli,et al.intravenous immunoglobulin as add on treatment with mycophenolate mofetil in severe myositis[J].Autoimmunity Reviews,2009
[2]顾越英.多发性肌炎和皮肌炎[M].内科学,2005,1100-1105
[3] Oddis CV.Current management of polymyositis and dermatomyositis,Drugs,1989,37(3):382-90
[4] Maria Giovanna danieli,et al.intravenous immunoglobulin as add on treatment with mycophenolate mofetil in severe myositis.Autoimmunity Reviews,2009
[5] Steven R,Treatment of Refractory Polymyositis and Dermatomyositis.Current Rheumatology Reports,2006,8:167-173
[6]Bohan A,Peter JB.Polymyositis and dermatomyositis(first of two parts)[J].N Engl J Med,1975,292(7):344-347.
[7]王国春.多发性肌炎和皮肌炎的诊治进展[J].临床内科学杂志,2007,24(7):442-445
[8]van der Meulen MF,Bronner IM,Hoogendijk JE.Polymyositis an overdiagnosed entity[J].Neurology,2003,316-321.
[9]Amato AA, Gronseth GS, Jackson CE, et al. Inclusion body myositis:clinical and pathological boundaries. Ann Neurol 1996;40:581-586.
[10]Hoogendijk J,Amato A,Lecky B,et a1.119th ENMC international workshop:the design in adult idiopathic inflam matory myopathies,with exception of inclusion body myositis,Neummuscul Disord ,2004,14:337-345.
[11]彭波.癌与皮肌炎的相关性研究[J].肿瘤研究与临床,2001,13(3):214-215
[12]Hill CL,Zhang Y,Sigurgeirsson B,et a1.Frequency of specific cancer types indermatomyositis and polymyositis: a population based studv.Lancet.200l,357(9250):96-100.
[13]Ponyi A.Constantin T. Garami M.et a1.Cancer-associated myositis:clinical features and prognostic signs.Ann N Y Acad Sci.2005.105l:64-71.
[14]刘彤.伴恶性肿瘤皮肌炎的研究进展.国际皮肤性病学杂志,2007,33(3):142-144
[15]Buchbinder& Hill C L.Malignancy in patients with inflammatory myopathy.Curr Rheumatol Rep,2002,4(5):415-426.
[16]Fathi,Maryama;Lundberg,IngIjd Eb.Interstitial lung disease in polymyositis and dermatomyositis.Curr Opin Rheumatol,Volume 1 7(6).November 2005,701—706.
[17]吴大玮.多发性肌炎/皮肌炎相关肺间质病变[J].山东医药.2007,47(32):148-149
[18]Takada T,et a1. Clinica1 features of polymyositis/dermatomyositis with steroid resistant interstitia1 lung disease.Intern Med,1998,37(8):669-673
[19]Yoshifuji H,Fujii T,Kobayashi S,et a1.Anti-aminoacyl-tRNA synthetase antibodies in clinical course prediction of interstitial lung disease complicated with idiopathic inflammatory myopathies.Autoimmunity,2006,39:233
[20]谢瑶,王国春.炎性肌病特异性自身抗体研究进展[J].内科急危重症杂志.2008,14(2):94-97
[21]Kerry BS,chester VO,Noreen F,et a1.Anti-Jo-1 antibody levels correlate with disease activity in idiopathic inflammatory myopathy.Arthritis Rheumatism,2007,56:3125.
[22]张健.多发性肌炎/皮肌炎患者血清抗Jo-1和Mi-2等6种自身抗体检测的意义.中国误诊学杂.2008,8(23):5548-5550
[23]Hengstman GJ.Vree Egberts W T,Seelig HP,et a1.Clinical characteristics of patients with myositis and autoantibodies to different fragments of the Mi-2 beta antigen.Ann Rheum INs,2006,65:242.
[24]黄春梅.多发性肌炎/皮肌炎自身抗体谱的研究进展[J].国际检验医学杂志.2006.27(1):33-37
[25]Coppo P,Clauvel JP,Bengoufa D,et a1.Inflammatory myositis associated with anti-Ul-small nuclear ribonucleoprotein antibodies:a subset of myosltis associated with a favourable outcome.Rheumatology (Oxford),2002,41(9) 1040-1046.
[26]吴庆军. Ku抗体在自身免疫性结缔组织病中的意义[J].中华风湿病学杂志.2001,5(1):23-25
[27]Bamberger C M ,Bamberger A M ,De Castro M et a1.Glucoc orticoid receptor beta,a potential endogen ous inhibitor of glucoc orticoid action in humans[J].J Clin invest,1995;95(6):2435-2441
[28]刘继峰.多发性肌炎/皮肌炎患者外周血单个核细胞中糖皮质激素受体α、βmRNA表达与糖皮质激素疗效相关性的研究[J].中国免疫学杂志,2007,23:364-367
[29]李久宏.糖皮质激素受体α及β在皮肌炎/多肌炎患者发病与治疗中的作用[J].中华风湿病学杂志,2007,11:679-681
[30]Takada T,uzuki E,et a1.Clinica1 features of polymyositis/dermatomyositis with steroid resistant interstitia1 lung disease.Intern Med,1998,37(8):669-673
[31]Fudman EJ,Schnitzer TJ.Dermatomyositis without creatine kinase elevation,A poor prognostic sign,Am J Med 80;329,1986
[2]Douche-Aourik F,Berlier W,Feasson L,et a1.Detection of enterovirus in human skeletal muscle from patients with chronic inflammatory muscle disease or fibromyalgia and healthy subjects.J Med Virol,2003,71(4):540—547
[3] Mastaglia FL, Zilko PJ. Inflammatory myopathies: how to treat the difficult cases. J Clin Neurosci 2003;10:99–101.
[4]Bohan A,Peter JB.Polymyositis and Dermatomyositis.N Engl J Med,1975,292:344-734,403-407.
[5]王吉耀主编.内科学[M].第1版.北京:人民卫生出版,2005:1100-1105
[6]Maugars YM,Berthelot J-MM,Abbas AA,et al. Prognosis of 69 patients with dermatomyositis or polymyositis.Clin Exp Rheum.1996,14:263
[7]阎乎玲.皮肌炎患者心脏损害185例临床分析[J].中国皮肤性病学杂志,2006,9:542-543
[8]佟胜全.多发性肌炎或皮肌炎心脏损害的临床分析[J].中华风湿病学杂志,2005,10,605-608
[9]刘芳,蒲传强.多发性肌炎合并心肌损害的临床特点[J].临床神经病学杂志,2005,18,97-99
[10] Fathi,Maryama;Lundberg,IngIjd Eb.Interstitial lung disease in polymyositis and dermatomyositis.Curr Opin Rheumatol,Volume 1 7(6).November 2005,701-706.
[11]吴大玮.多发性肌炎/皮肌炎相关肺间质病变[J].山东医药.2007,47(32):148-149
[12]帅茂圣,刘元梁.系统性红斑狼疮与皮肌炎重叠综合征1例[J].中国麻风皮肤病杂志,2008,24(8),588
[13]Yves Troyanov.Novel Classification of Idiopathic Inflammatory Myopathies Based on Overlap Syndrome Features and Autoantibodies :Analysis of 100 French Canadian Patients. Medicine 2005;84:231–249
[14]Dalakas MC, Hohlfeld R. Polymyositis and dermatomyositis. Lancet 2003;362:971-82
[15]Yiannis loannou,Myositis overlap syndromes.Current Opinion in Rheumatology 1999,11:468-474
[16]BuchbinderR,Hill C L.Malignancy in patients with inflammatory myopathy.CurrRheumatol Rep,2002,4(5):415-426.
[17]Airio A,Kautiainen H,Hakala M.Prognosis and mortality of polymyositis and dermatomyositis patients.Clin Rheumatol,2006,25(2):234-239
[18]甄莉.皮肌炎合并心脏异常危险因素的研究[J].实用预防医学,2006,2(13),44-46
[19]Toshinori TAKADA.Clinical Features of Polymyositis/Dermatomyositis with Steroid-Resistant Interstitial Lung Disease.Internal Medicine 1998,37:669-673
[20]EDWARD J.FUDMAN.Dermatomyositis without Creatine Kinase Elevation A Poor Prognostic Sign.The American Journal of Medicine 1986,329-332
[21]BRAHIM TABARKI.Childhood dermatomyositis:Clinical course of 36 patients treated with low doses of corticosteroids.European Journal of Paediatric Neurology 1998;2:205-211
[22]Sparsa A,Liozon E,Herrmann F,et a1.Routine vs extensive malignancy search for aduh dennatomyositis and polymyositis:a study of 40 patients.Arch Dennatol,2002,138(7):885-890.
[23]戴冽.甲状腺功能减退性多发性肌炎样综合征57例回顾分析[J].中华风湿病学杂志2007,12,738-741
[24]Milanov L,Ishpekova B.Differential diagnosis of chronic idiopathic polymyositis and neuromyositis.Electromyogr Clin Neurophysio1.1998;38(3):183-187
[25]宋玉强,沈定国.多发性肌炎和皮肌炎患者的临床和肌电图分析[J].临床神经电生理学杂志,2002,11,217-219
[26]崔丽英.皮肌炎和多发性肌炎175例神经传导检测[J].中华神经科杂志,2009,42,608-610
[27]实用神经病学,史玉全,1992,第二版
[28]Coppo P,Clauvel JP,Bengoufa D,et a1.Inflammatory myositis associated with anti-Ul-small nuclear ribonucleoprotein antibodies:a subset of myosltis associated with a favourable outcome.Rheumatology (Oxford),2002,41(9) 1040-1046.
[29]van der Meulen MF,Bronner IM,Hoogendijk JE.Polymyositis an overdiagnosed entity.Neurology,2003,316-321.
[30]Hoogendijk J,Amato A,Lecky B,et a1.119th ENMC international workshop:thedesign in adult idiopathic inflam matory myopathies,with exception of inclusion body myositis,Neummuscul Disord ,2004,14:337-345.
[31]Tabarki B, Ponsot G, Prieur AM, Tardieu M. Childhood dermatomyositis: clinical course of 36 patients treated with low doses of corticosteroids. Eur J Pediatr Neurol 1998,2:205–211
[32]Oddis CV.Current management of polymyositis and dermatomyositis,Drugs,1989,37(3):382-90
[33]Maria Giovanna danieli,et al.intravenous immunoglobulin as add on treatment with mycophenolate mofetil in severe myositis.Autoimmunity Reviews,2009
[34]Steven R,Treatment of Refractory Polymyositis and Dermatomyositis.Current Rheumatology Reports,2006,8:167-173
[1]Maria Giovanna danieli,et al.intravenous immunoglobulin as add on treatment with mycophenolate mofetil in severe myositis[J].Autoimmunity Reviews,2009
[2]顾越英.多发性肌炎和皮肌炎[M].内科学,2005,1100-1105
[3] Oddis CV.Current management of polymyositis and dermatomyositis,Drugs,1989,37(3):382-90
[4] Maria Giovanna danieli,et al.intravenous immunoglobulin as add on treatment with mycophenolate mofetil in severe myositis.Autoimmunity Reviews,2009
[5] Steven R,Treatment of Refractory Polymyositis and Dermatomyositis.Current Rheumatology Reports,2006,8:167-173
[6]Bohan A,Peter JB.Polymyositis and dermatomyositis(first of two parts)[J].N Engl J Med,1975,292(7):344-347.
[7]王国春.多发性肌炎和皮肌炎的诊治进展[J].临床内科学杂志,2007,24(7):442-445
[8]van der Meulen MF,Bronner IM,Hoogendijk JE.Polymyositis an overdiagnosed entity[J].Neurology,2003,316-321.
[9]Amato AA, Gronseth GS, Jackson CE, et al. Inclusion body myositis:clinical and pathological boundaries. Ann Neurol 1996;40:581-586.
[10]Hoogendijk J,Amato A,Lecky B,et a1.119th ENMC international workshop:the design in adult idiopathic inflam matory myopathies,with exception of inclusion body myositis,Neummuscul Disord ,2004,14:337-345.
[11]彭波.癌与皮肌炎的相关性研究[J].肿瘤研究与临床,2001,13(3):214-215
[12]Hill CL,Zhang Y,Sigurgeirsson B,et a1.Frequency of specific cancer types indermatomyositis and polymyositis: a population based studv.Lancet.200l,357(9250):96-100.
[13]Ponyi A.Constantin T. Garami M.et a1.Cancer-associated myositis:clinical features and prognostic signs.Ann N Y Acad Sci.2005.105l:64-71.
[14]刘彤.伴恶性肿瘤皮肌炎的研究进展.国际皮肤性病学杂志,2007,33(3):142-144
[15]Buchbinder& Hill C L.Malignancy in patients with inflammatory myopathy.Curr Rheumatol Rep,2002,4(5):415-426.
[16]Fathi,Maryama;Lundberg,IngIjd Eb.Interstitial lung disease in polymyositis and dermatomyositis.Curr Opin Rheumatol,Volume 1 7(6).November 2005,701—706.
[17]吴大玮.多发性肌炎/皮肌炎相关肺间质病变[J].山东医药.2007,47(32):148-149
[18]Takada T,et a1. Clinica1 features of polymyositis/dermatomyositis with steroid resistant interstitia1 lung disease.Intern Med,1998,37(8):669-673
[19]Yoshifuji H,Fujii T,Kobayashi S,et a1.Anti-aminoacyl-tRNA synthetase antibodies in clinical course prediction of interstitial lung disease complicated with idiopathic inflammatory myopathies.Autoimmunity,2006,39:233
[20]谢瑶,王国春.炎性肌病特异性自身抗体研究进展[J].内科急危重症杂志.2008,14(2):94-97
[21]Kerry BS,chester VO,Noreen F,et a1.Anti-Jo-1 antibody levels correlate with disease activity in idiopathic inflammatory myopathy.Arthritis Rheumatism,2007,56:3125.
[22]张健.多发性肌炎/皮肌炎患者血清抗Jo-1和Mi-2等6种自身抗体检测的意义.中国误诊学杂.2008,8(23):5548-5550
[23]Hengstman GJ.Vree Egberts W T,Seelig HP,et a1.Clinical characteristics of patients with myositis and autoantibodies to different fragments of the Mi-2 beta antigen.Ann Rheum INs,2006,65:242.
[24]黄春梅.多发性肌炎/皮肌炎自身抗体谱的研究进展[J].国际检验医学杂志.2006.27(1):33-37
[25]Coppo P,Clauvel JP,Bengoufa D,et a1.Inflammatory myositis associated with anti-Ul-small nuclear ribonucleoprotein antibodies:a subset of myosltis associated with a favourable outcome.Rheumatology (Oxford),2002,41(9) 1040-1046.
[26]吴庆军. Ku抗体在自身免疫性结缔组织病中的意义[J].中华风湿病学杂志.2001,5(1):23-25
[27]Bamberger C M ,Bamberger A M ,De Castro M et a1.Glucoc orticoid receptor beta,a potential endogen ous inhibitor of glucoc orticoid action in humans[J].J Clin invest,1995;95(6):2435-2441
[28]刘继峰.多发性肌炎/皮肌炎患者外周血单个核细胞中糖皮质激素受体α、βmRNA表达与糖皮质激素疗效相关性的研究[J].中国免疫学杂志,2007,23:364-367
[29]李久宏.糖皮质激素受体α及β在皮肌炎/多肌炎患者发病与治疗中的作用[J].中华风湿病学杂志,2007,11:679-681
[30]Takada T,uzuki E,et a1.Clinica1 features of polymyositis/dermatomyositis with steroid resistant interstitia1 lung disease.Intern Med,1998,37(8):669-673
[31]Fudman EJ,Schnitzer TJ.Dermatomyositis without creatine kinase elevation,A poor prognostic sign,Am J Med 80;329,1986