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目的分析非创伤性横纹肌溶解症(RML)的诱发因素及其临床特点、预后。方法回顾性分析本院1995—2006年13例非创伤性RML住院患者,所有患者均有完整的病史、体格检查、实验室检查等资料。结果13例中多诱因发病者8例,单一诱因发病者5例;可能的诱发因素包括高强度运动6例,高热3例,药物因素3例,毒品、非诺贝特、环孢素各1例;继发于炎性肌病3例,肢体受压2例。临床表现为肌痛、肌无力9例,神经系统异常6例,高热4例,消化道症状3例。并发凝血功能障碍9例,急性肾功能衰竭(ARF)6例。肌酸激酶(CK)6例在1个月左右降至正常,1例由非诺贝特诱发者,同时患糖尿病、慢性肾功能不全,CK在第60天恢复正常;3例继发于炎性肌病者CK恢复较慢,1例随访80 d未降至正常,另2例分别在4个月、6个月时降至正常;3例死亡患者均为多因素诱发,均并发ARF、凝血障碍、电解质及代谢紊乱。结论非创伤性RML最常见发病因素是高强度运动;其次为药物、炎性肌病。多种发病因素、ARF提示预后不好。
Objective To analyze the predisposing factors, clinical features and prognosis of non-traumatic rhabdomyolysis (RML). Methods A retrospective analysis of our hospital from 1995 to 2006, 13 cases of non-invasive RML hospitalized patients, all patients have a complete history, physical examination, laboratory tests and other data. Results Among 13 cases, there were 8 cases of multiple predisposition and 5 cases of single predisposition. The possible inducing factors included 6 cases of high intensity exercise, 3 cases of fever, 3 cases of drug, 3 cases of drug, fenofibrate and 1 case of cyclosporine Cases; secondary to inflammatory myopathy in 3 cases, 2 cases of limb compression. Clinical manifestations of myalgia, muscle weakness in 9 cases, 6 cases of abnormal nervous system, fever in 4 cases, gastrointestinal symptoms in 3 cases. 9 cases of coagulation dysfunction, acute renal failure (ARF) in 6 cases. Six cases of creatine kinase (CK) decreased to normal in one month, one case was induced by fenofibrate, with diabetes and chronic renal insufficiency. CK returned to normal on the 60th day. Three cases of secondary inflammation The recovery of CK in patients with myopathies was slow, one case did not decrease to normal after 80 days of follow-up, and the other two cases were normal at 4 months and 6 months respectively. All three died patients were induced by multiple factors, all with ARF, Coagulation disorders, electrolyte and metabolic disorders. Conclusions The most common risk factor for non-invasive RML is high-intensity exercise, followed by medications and inflammatory myopathies. A variety of risk factors, ARF prompted a poor prognosis.