科研之友
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摘要
objective: to identify risk factors associated with calcinosis in children and adolescents with juvenile dermatomyositis. methods: a review was carried out of the medical records of 54 patients with juvenile dermatomyositis. data were collected on demographic characteristics, clinical features: muscle strength (stages i to v of the medical research council scale), pulmonary involvement (restrictive pulmonary disease with presence or absence of anti-jo1 antibodies), gastrointestinal problems (gastroesophageal reflux) and/or heart disease (pericarditis and/or myocarditis); laboratory tests: elevated muscle enzyme levels in serum (creatine phosphokinase, aspartate aminotransferase, alanine aminotransferase and/or lactate dehydrogenase); and on the treatments given: corticoid therapy in isolation or associated with hydroxychloroquine and/or immunosuppressants. the patients were divided into two groups, depending on presence or absence of calcinosis and data were evaluated by both univariate and multivariate analyses. results: calcinosis was identified in 23 (43%) patients, and in six (26%) patients it had emerged prior to diagnosis while in 17 (74%) it was post diagnosis. the univariate analysis revealed that cardiac (p = 0.01) and pulmonary (p = 0.02) involvement and the need for one or more immunosuppressor (methotrexate, cyclosporine a and/or pulse therapy with intravenous cyclophosphamide) to treat juvenile dermatomyositis (p = 0.03) were all associated with an increased incidence of calcinosis. the multivariate analysis then demonstrated that only cardiac involvement (or = 15.56; 95%ci 1.59-152.2) and the use of one or more immunosuppressor (or = 4.01; 95%ci 1.08-14.87) were independently associated with the presence of calcinosis. conclusions: calcinosis was a frequent development among these juvenile dermatomyositis cases, generally emerging as the disease progressed. calcinosis was associated with the more severe cases that also had cardiac involvement and where
