摘要
报告1例他汀类药物导致的自身抗体阴性的免疫性坏死性肌病。患者女,67岁,因全身乏力、四肢肌肉酸痛3个月,加重1个月就诊。既往口服他汀类降血脂药10年。皮肤科检查:全身未见皮损,蹲起费力,四肢肌肉无明显萎缩,肌力Ⅳ级,双上肢及大腿肌肉轻度握痛。实验室检查:血沉34 mm/h,AMA-M2(WB)+++,CK 530 U/L,CK-MB 830 U/L,抗信号识别粒子抗体、抗3-羟基3-甲基戊二酰辅酶A还原酶抗体及皮肌炎特异性抗MDA5阴性、LDH正常。肌电图检查肱二头肌、胫前肌显示肌源性损害。肱二头肌活检行病理组织学检查,显示肌纤维轻度变性,但无炎性细胞浸润。四肢肌肉磁共振检查未见异常。诊断:自身抗体阴性的免疫性坏死性肌病。经过系统使用糖皮质激素和吗替麦考酚酯治疗后,肌痛、肌无力消失,实验室检查指标明显好转,巩固治疗1年,随访至今未复发。
A case of statin-induced immune necrotizing myopathy with negative autoantibodies is reported.A 67-year-old female presented with generalized weakness and limb muscle soreness for 3 months,with worsening symptoms over the past month.She had been taking statins orally for lipid-lowering therapy for 10 years.Skin examination revealed no skin lesions throughout the body.Patient had difficulty to squat and stand up,without muscle atrophy in the limbs.Muscle strength was gradeⅣ,and there was mild tenderness upon palpation of the upper limbs and thigh muscles.Laboratory tests showed an ESR of 34 mm/h,AMA-M2(WB)strongly positive(+++),CK level of 530 U/L,CK-MB level of 830 U/L,and negative for anti-signal recognition particle antibody,anti-3-hydroxy-3-methylglutaryl-CoA reductase antibody,and dermatomyositis-specific anti-MDA5.LDH was normal.Electromyography showed myogenic damage in the biceps brachii and anterior tibial muscles.Biopsy of the biceps brachii revealed mild muscle degeneration,with no inflammatory cell infiltration.Magnetic resonance imaging of the limbs showed no abnormalities.Clinical diagnosis was seronegative immune-mediated necrotizing myopathy.After systematic treatment with glucocorticoids and mycophenolate mofetil,muscle pain and weakness resolved,and the laboratory test indicators improved significantly.After one year of maintenance therapy,there has been no recurrence to date.
作者
崔琳
谢冰欣
张士发
CUI Lin;XIE Bingxin;ZHANG Shifa(Northeast International Hospital,Shenyang 110623,China)
出处
《皮肤性病诊疗学杂志》
2025年第8期589-593,共5页
Journal of Diagnosis and Therapy on Dermato-venereology
关键词
免疫性坏死性肌病
自身抗体
诊断
治疗
immune-mediated necrotizing myopathy
autoantibody
diagnosis
treatment
