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目的: ステロイドミオパチーの診断における%クレアチン尿{尿中クレアチン/(尿中クレアチン+尿中クレアチニン)}の有用性について再検討を行う。
方法:ステロイド内服を予定した症例に対し,内服開始前に%クレアチン尿を算出した。尿クレアチン・クレアチニン排泄量は酵素法にて測定した。
結果:対象は26例(男性14例,女性12例)で,%クレアチン尿(中央値)は男性2.5%,女性17.1%であり,女性において有意に高値であった(p=0.041)。カットオフ値として知られる10%を超えた症例は,男性3/14例(21.4%),女性8/12例(66.7%)と高頻度であった。
結語:%クレアチン尿をステロイドミオパチーの診断に使用する際に,カットオフ値として10%を使用することには問題がある。さらにその測定はステロイド内服開始前にも行うこと,測定値は測定法や性差,腎機能により影響を受けることを認識することが重要である。
Steroid myopathy is usually a slowly progressive disease, which causes weakness primarily to the proximal muscles of the upper and lower extremities. The monitoring of this problem is difficult in situations in which the primary disease itself produces muscle weakness. The distinguishing feature in steroid myopathy is the occurrence of creatinuria in the presence of normal muscle enzymes including creatine kinase and aldolase. To evaluate the usefulness of percent creatinuria {urinary excretion of creatine/(urinary excretion of creatine + urinary excretion of creatinine)} in the diagnosis of steroid myopathy, we measured percent creatinuria in 26 patients (14 male and 12 female) without muscle diseases before the initiation of steroid treatment. We found that the median values of percent creatinuria of the male and female patients were 2.5% and 17.1%, and that the ratios of the male and female patients presenting with an elevated percent creatinuria (more than 10%) were 3 out of 14 patients (21.4%) and 8 out of 12 patients (66.7%), respectively. We also found one patient with mild renal dysfunction presenting with an elevated percent creatinuria but without muscle weakness or myalgia. These findings suggest that the measurement of percent creatinuria is of little value in the diagnosis of steroid myopathy with a cutoff value of 10%. Furthermore, it is important to measure percent creatinuria before the steroid treatment, while paying close attention to the measurement method, sex, renal function and protein level of the diet.
(Received : June 15, 2005)
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