|
楼主 |
发表于 2008-12-10 09:58:40
|
显示全部楼层
友情提示:风趣爱康(www.iKang.org)是类风湿公益论坛,网友言论只代表本人观点,请大家文明发言!
67-10-第十节 预 后
随着免疫抑制治疗的出现,特发性炎性肌病的预后不断改善。皮质激素出现前成人特发性炎性肌病的5年生存率为60%,1947一1968年为 68%,近几年为 80 。用通信方式对1986一1998年的59例特发性炎性肌病病人进行了随访,一年生存率为90%,2-5年生存率为80%。前5年共死亡12例,其中死于肺内感染5例,肺纤维化4例,肿瘤3例。发病前3年病情较重,激素用量大,激素减量或停用时病情易复发;发病5年后病情趋于稳定,有三分之一的病人脱离激素,病情仍保持稳定。我们的病人多数较重,病例也较少,因此,这些统计数字与实际情况可能会有差异,它只是在一定程度上也反映了一种趋向。除使用免疫抑制剂外,早诊断早治疗,以及有效控制并发症也有助于预后的改善。
5 M+ s) F5 I8 K# K6 O8 W% y (吴东海)
9 Z! _! U7 h" U$ [ e% s( B 参考文献:
- i/ Y+ c' V/ T- U z. P1 ~4 J1 V; H5 s3 H# k3 u: R8 ~* |0 _
马丽,王丽英,侯广庆,等 皮肌炎多发性肌炎59例随访.中华风湿病学杂志,5:59一61
4 t% k( u. E( E; i$ G! ?) l T
7 P. W& \% u$ ]% @ Askanas V, Engel W N. Sporadic inclusion-body myositisand hereditary inclusion body myopathies: current concepts of di-agnosis and pathogenesis. Curr Opin Rheumatol, 1998.10:530 % ~, [5 \0 c' @; T; s" v/ c
8 x( v- a% S4 S" Q* k
Ausem M G E M, Lochman P, van Diggelen O P, et al. Adiagnostic test for adult-onset glycogen storage disease type 11.Neurology, 1999.52:851
/ J1 F/ N# G. p, R) |5 Q* I* O; t0 K d& ^; w' e8 {0 O% ^2 O
Behrens L, Bender A, Johnson M A, et al. Cytotoxic mech-anisms in inflammatory myopathied co-expression of Fas and pro-tective Bcl-2 in muscle fibers and inflammatory cells. Brain,1997. 120:9298 b: V* F% h" H8 k
1 X2 ]! {* Q- Y* k. X7 G5 @- j
Dalakas M C,Dambrosia J M. A controlled trial of high-doseintravenous immuneglobulin infusions as treatment for dermato-myositis. N Engl J Med, 1993. 329:1993一2000
2 [9 w. \) r0 f Z: p
7 N6 V" P4 K1 l: V Fafalak R G, Peterson M G, Kagen L J. The strength inpolymyositis and dermatomyositis: best outcome in patients treat-ed early. J Rheumatol, 1994.21:643一648 - N+ L( f+ o# t) x$ j7 X8 w
" P8 v6 w+ v6 e" W! j5 a r Fyher I-M, Moslemi A-R, Mosavia A, et al. Oligoexpres-sion in muscle infiltrating T cells in inclusion body myositis. JNeuroimmunol 1997.79:185
+ r) A+ {$ v m) f7 ^' s# H7 g4 M5 |7 E0 z$ W5 y: E
Garlepp M J, Mastaglia F L. Inclusion body myositis. JNeurol Neurosurg Psychiatry, 1996. 60:251一258 0 H9 S! K2 Z) j: B8 K
Garton M J, Isenberg D A. Clinical features of lupus myosi-tis versus idiopathic myositis: A review of 30 cases. Br JRheumatol, 1997.36:1067
, C- \& _2 e6 r" U+ E$ s: g( }9 }& r/ I8 |1 V( M& N" u3 s
Goebels N, Michaelis D, Engelhardt M, et al. Differentialexpression of perforin in muscle-infiltrating T cells in polymyositisand dermatomyositis. J Clin Invest, 1996.97:2905 9 g- N- \4 ^+ x# R. E% g
' M5 Y2 R# H: C) G3 i7 I) r Gonzalez-Lopez L, Gamez-Nava JI, Sanchez L, et al. Car-diac manifestations in dermato-polymyositis. Clin Exp Rheumatol1996. 14:373
3 N C6 d; ?1 u! [6 {: V" d) p1 o7 m: p
Mantegazza R, Bernasconi P, Confalonieri P, et al. Inflam-matory myopathies and systemic disorders: a review of im-munopathogenetic mechanisms and clinical features. J Neurol,1997. 244:277
$ r& P& k6 E& e! @6 @+ I3 X/ Z$ {2 [' I! i, ]$ K6 \2 J
Marie 1, Horton P-Y, Hachulla E, et al. Pulmonary in-volvement in polymyositis and in dermatomyositis. J Rheumatol,1998. 25:1336+ l0 O' L$ D& u7 s
+ E+ G9 A3 B; {1 e
Naparstek Y, Plotz P H. The role of autoantibodies in au-toimmune disease. Ann Rev Immunol, 1993.11:79一104
+ J- y) Z# H6 f1 ]( @6 O6 m; U6 f! \2 A/ T- L
Pascuzzi R M. Drugs and toxins associated with myopathies.Curr Opin Rheumatol, 1998.10:511 7 {6 z, q2 Y) h% `0 }
) m7 f7 A; t8 x' Q: E+ V
Pickering M C, Walport M J. Eosinophilic myopathic syn-dromes. Curr Opin Rheumatol,1998. 10:504% f4 b" e2 i; n. L( r# V" L
2 h; J# q% f: j* i% a& D
Plotz P H, Rider L G,Targoff I N, et al. NIH conference.Myositis: immunologic contributions to understanding cause,pathogenesis and therapy. Ann Intern Med, 1995-122: 715一724
4 X& [/ l% u! j3 S! Y/ O% A8 I0 \
Robert L. Wortmann. Inflammatory Diseases of Muscle andOther Myopathies. Kelley’s Textbook of Rheumatology, 6thEd,W. B. Saunders Company. 2001
. b( c9 p( e" ^3 r, [, o% u! g$ x) q( w# L/ b; C9 o
Sieb J P, Ries F, Traber, et al. Recurrent focal myositis.Muscle Nerve, 1997. 20:1205 2 y, |% n1 |/ }; T
}; I5 M0 L. O, Y2 Z/ |! L2 B Targoff I N, Miller F W, Medsger T A Jr, et al. Classifica-tion criteria for the idiopathic inflammatory myopathies. CurrOpin Rheumatol, 1997.9:527 2 Q* O# A, M* b) i
- `, s8 b& M% f' h6 B
Villalba L, Hicks J E, Adams E M, et al. Treatment of re-fractory myositis. Arthritis Rheum 1998. 41:392 ; P3 I" `. W4 @1 S2 n; b
& m2 R0 L! f! p* @/ L Whitemore S E, Watson R, Rosenshein N B, et al. Der-matomyositis sine myositis: Association with malignancy. JRheumatol, 1996.23:1010
* r& L: c$ I- H) S+ r4 Q p) \& a/ p9 Z$ v
Zieglschmid M E, Pandya A G, Cohen S B, et al. Treat-ment of dermatomyositis with methotrexate. J Am Acad Derma-tol, 1995.32:754一757 |
|