EFNS guidelines on the diagnostic approach to pauci- or asymptomatic hyperCKemia
EFNS guidelines on the diagnostic approach to pauci- or asymptomatic hyperCKemia
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DOI：
10.1111/j.1468-1331.2010.03012.x
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发表时间：
2010-06-01
影响因子：
5.1
通讯作者：
Hilton-Jones, D.
中科院分区：
文献类型：
--
作者：
Kyriakides, T.;Angelini, C.;Hilton-Jones, D.
目的：提供以证据为基础的准则，一般神经科医生的评估患者与缺乏或无症状hyperCKemia.Background：最近的流行病学研究表明，高达20%的“正常”的个人有一个升高的血清肌酸激酶活性（sCK）。亚临床肌病的可能性经常被提出，患者可能会被不必要地拒绝接受他汀类药物治疗。检索策略：电子数据库包括Medline、科克伦图书馆和美国神经病学学会，检索现有的指南。文章处理一系列的患者调查无症状/少症状的高CK血症和文章处理肌病，可以呈现无症状的高CK血症进行了鉴定和review.Results：唯一的指南发现的是那些批准的意大利协会的肌肉学委员会，和唯一相关的文章确定描述类IV study.Recommendations：高CK血症需要重新定义为值超过正常上限的1.5倍（本身需要适当定义）。如果存在以下一种或多种情况，则可以通过肌肉活检对无明显医学解释的少量或无症状高CK血症进行研究：sCK>= 3倍正常值，肌电图为肌病或患者< 25岁。此外，sCK < 3倍正常值的女性可能会被提供DNA检测，因为可能携带抗肌萎缩蛋白突变。
Objective:To provide evidence-based guidelines to general neurologists for the assessment of patients with pauci- or asymptomatic hyperCKemia.Background:Recent epidemiologic studies show that up to 20% of 'normal' individuals have an elevated creatine kinase activity in the serum (sCK). The possibility of a subclinical myopathy is often raised, and patients may be unnecessarily denied treatment with statins.Search strategy:Electronic databases including Medline, the Cochrane Library and the American Academy of Neurology were searched for existing guidelines. Articles dealing with series of patients investigated for asymptomatic/pauci-symptomatic hyperCKemia and articles dealing with myopathies that can present with asymptomatic hyperCKemia were identified and reviewed.Results:The only guidelines found were those approved by the Italian Association of Myology Committee, and the only relevant articles identified describe class IV studies.Recommendations:HyperCKemia needs to be redefined as values beyond 1.5 times the upper limit of normal (which itself needs to be appropriately defined). Pauci- or asymptomatic hyperCKemia with no apparent medical explanation may be investigated with a muscle biopsy if one or more of the following are present; the sCK is >= 3x normal, the electromyogram is myopathic or the patient is < 25 years of age. In addition, women with sCK < 3 times normal may be offered DNA testing because of the possibility of carrying a dystrophin mutation.