摘要
目的探讨不同病因所致横纹肌溶解综合征(RM)的临床与实验室检查特点。方法回顾性分析144例不同病因RM患者的临床特征及诊治经过。结果144例RM患者中男女比例为2.27∶1,年龄13~82岁。前3位RM病因依次为运动(36.81%)、感染(15.28%)及血管闭塞(13.19%)。运动是≤60岁患者最常见病因(≤30岁70.69%、31~60岁23.08%),而血管闭塞是≥61岁患者最常见病因(41.18%)。RM经典三联征中以肌痛最为常见(72.92%),而肌无力(47.22%)、茶色尿(31.94%)仅见于不足半数的患者。不同病因导致的RM患者肌酸激酶(CK)(P=0.002)、肌酸激酶同工酶(CKMB)(P=0.000)、肌红蛋白(P=0.009)、胱抑素C(P<0.001)组间差异具有统计学意义。22.9%RM患者发生急性肾损伤(AKI),6.3%患者发生多脏器功能障碍综合征(MODS)。所有患者接受补液、碱化尿液治疗,29.17%患者加用连续性肾替代治疗(CRRT),4.86%患者死亡。结论RM病因构成具有年龄差异,运动、血管闭塞分别是≤60岁、≥61岁患者最常见病因。RM临床表现以肌痛最为常见,变异度大。治疗应结合基础疾病,多数患者经补液、碱化尿液,间或加用CRRT预后良好。
Objective To explore the clinical and laboratory characteristics of rhabdomyolysis(RM)with different etiologies.Methods The clinical characteristics,diagnosis and treatment of 144 patients with RM were retrospectively analyzed.Results The patients aged 13~82 years old and the ratio of male to female was 2.27∶1.The top three etiologies were exercise(36.81%),infection(15.28%)and vascular occlusion(13.19%).RM in patients≤30 years old was mainly induced by exercise(70.69%),and vascular occlusion was the most common cause of patients≥61 years old(41.18%).The most common symptom was myalgia(72.92%).Muscle weakness(47.22%)and tea-colored urine(31.94%)were seen in less than half of the patients.Among different etiologies,vascular occlusion had the highest positive rate of myalgia(100%).Exercise-induced RM had higher positive rate of typical RM symptoms than other physical injuries.CK(P=0.002),CKMB(P=0.000)and myoglobin(P=0.009)varied among patients with different etiologies.Statistical difference was also observed in cystatin C.Acute kidney injury(AKI)and multiple organ dysfunction syndrome(MODS)occurred in 22.9%and 6.3%of the patients,respectively.All the patients received fluid replacement and alkalization treatment,and 29.17%of the patients received continuous renal replacement therapy(CRRT).The mortality rate was 4.86%in total.Conclusion Etiological composition of RM varies among different age groups.Exercise and vascular occlusion are the most common causes of patients≤60 years old and≥61 years old,respectively.Clinical manifestations are highly variable,and myalgia is the most common symptom.Treatment should be adjusted according to the etiologies.Prognosis is good for most patients after rehydration,alkalization and some cases of CRRT.
作者
高楚淇
强薇
王金龙
李梦祎
陈蕾
单媛媛
李昊
吕杰
施秉银
Gao Chuqi;Qiang Wei;Wang Jinlong;Li Mengyi;Chen Lei;Shan Yuanyuan;Li Hao;Lyu Jie;Shi Bingyin(Department of Endocrinology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an Shaanxi 710061,China;Department of Blood Purification,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an Shaanxi 710061,China;Department of Pharmacy,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an Shaanxi 710061,China;Department of Intensive Care Unit,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an Shaanxi 710061,China;Department of Emergency,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an Shaanxi 710061,China)
出处
《遵义医科大学学报》
2020年第5期629-634,共6页
Journal of Zunyi Medical University
基金
国家自然青年基金资助项目(NO:81802829)
陕西省自然基础研究项目(NO:2020JQ-501)。
