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病毒性肌炎

Author
Marc L Miller, MD
Section Editors
Ira N Targoff, MD
Jeremy M Shefner, MD, PhD
Deputy Editor
Monica Ramirez Curtis, MD, MPH
Translators
谈文峰, 副主任医师，副教授

引言

病毒感染相关性肌肉综合征的临床表现轻则可以为常见的良性肌痛，重则可以为横纹肌溶解伴肌红蛋白尿性肾衰竭。

本专题将总结这些疾病的临床特征、病理学特征和诊断特点。肌无力成人和儿童患者的评估，以及横纹肌溶解的病因、临床表现和诊断，将单独讨论。 (参见“肌无力患者的临诊应对”和“儿童肌无力的病因和评估”和“横纹肌溶解症的病因”和“横纹肌溶解的临床表现与诊断”)

肌痛

轻度至中度弥漫性肌痛常发生在任何急性病毒感染的前驱期或早期。背部和四肢近端常受累，可能出现轻微肌肉压痛且不伴肌无力或提示肌肉炎症或坏死的实验室异常。这些自限性肌痛的原因可能是病毒诱导的细胞因子作用于肌肉组织，而不是病毒直接侵入肌肉所致[1]。

良性急性儿童期肌炎

伴随急性病毒感染而发生的中间型肌肉综合征主要见于儿童[2]。其具有明显的疼痛和压痛，通常局限于小腿。据报道，该表现最常见于甲型或乙型流感病毒感染。其常发生于流感流行期间，在2009-2010年甲型流感(H1N1)病毒大流行时曾有过相关描述[3]。其发生在急性疾病消退时，通常在发热、咳嗽和鼻炎这些主诉症状消退后24-48小时。

患者通常会由于疼痛或真正的肌无力而拒绝行走或难以行走。踝关节呈跖屈位，患者因疼痛而抵抗尝试背屈踝关节[4,5]。良性急性儿童期肌炎应被纳入到儿童突发性行走困难的鉴别诊断中[6]。

          

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Literature review current through: 2017-06 . | This topic last updated: 2015-12-14.
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