摘要
一位65歲女性在數月間逐漸出現疲勞及四肢近端肌內無力，實驗室數據發現起初單獨之GOT、GPT異常，提醒我們潛在的肝臟病變。在排除病毒、藥物、代異常、及其他全身性疾病導致的肝臟損傷後，推測免疫介導性機制可能是其原因。其後病患次出現呼吸困難、CPK升高、及抗核抗體(ANA)陽性，經病理診斷證實為侵犯雙側大腿、胸壁肌內的多發性肌炎，合併肺炎、漿膜炎(肋膜、心包膜)、及肝臟侵犯。根據過去文獻記載，多發性肌炎在生化數據上主要為CPK、GOT、LDH的上升。本病例係起初以合併肝功能異常來表現的近端肌無力，最後診斷盥多發性肌炎合併肝炎，殊為少見，值得臨床上診治之參考。病人在臨床症狀及生化數據上的改善程度皆與類固醇使用劑量成正相關。本病例提醒我們當面對多發性肌炎兼具異常肝功能數據時，應小心檢查肝臟是否亦受到侵犯。(慈濟醫學 1998;10:157-163)
並列摘要
A 65-year-old woman was found to have slowly progressive fatigue and weakness of all four proximal limbs of several months’ duration. Initial laboratory studies revealed elevated serum transaminase but normal creatine phosphokinase (CPK) levels. An immune-mediated process was believed to be the mechanism of hepatic injury, after the exclusion of viral, metabolic, and other systemic factors. Later, progressive muscle weakness and dyspnea were noted with a positive antinuclear antibody test and a markedly elevated CPK level found. Muscle tissue and liver biopsies confirmed the diagnosis of polymyositis with liver involvement. Further studiese revealed the polymyositis in this case was complicated with pneumonitis and serositis (pleuritis and pericarditis). Compared with the typical presentation of polymyositis showing elevated CPK, aspartate aminotransferase and lactate dehydrogenase levels, the initial clinical course in this case presented as abnormal liver function deserved only careful diagnosis and follow-up. The trends of clinical symptoms and the elevations of transaminase and CPK levels were parallel to the response to steroid dosage in this case. It reminds us to search for any associated liver disease when facing a patient with both polymyositis and abnormal liver function. (Tzu Chi Med J 1998;10:157-163)
延伸閱讀
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