Urinary levels of creatine and other metabolites in the assessment of polymyositis and dermatomyositis
Urinary levels of creatine and other metabolites in the assessment of polymyositis and dermatomyositis
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DOI：
10.1093/rheumatology/keg084
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发表时间：
2003-02-01
期刊：
影响因子：
5.5
通讯作者：
Scott, DL
中科院分区：
文献类型：
--
作者：
Chung, YL;Wassif, WS;Scott, DL
背景需要一种简单可靠的方法来评估疾病的活动性和监测治疗对多发性肌炎（PM）和皮肌炎（DM）的疗效。本研究使用体外质子（H-1）磁共振波谱（MRS）来探讨尿代谢产物的排泄是否可以作为PM和DM患者疾病的可靠标志物。尿液样本来自PM/DM患者（n = 34）、健康对照（50）和已知肌肉萎缩疾病的受试者，包括成人型肌营养不良症（8）、中风患者（10）、类风湿性关节炎（RA）类固醇患者（13）和非类固醇患者（16）以及酒精性肌病患者（12）。尿代谢物水平与肌酸激酶（CK）活性和股四头肌;肌肉力量。在35例PM/DM患者中的26例，60例其他医学疾病患者中的4例（包括1例成人发病的营养不良，1例中风和2例未使用类固醇的RA患者）和50例健康对照中的10例中，尿中检测到肌酸。20例PM/DM患者尿肌酸/肌酐比值超过0.4，但无其他疾病患者和健康对照。通过Kruskal-Wallis检验（比较所有组）和Mann-Whitney U检验（比较PM/DM病例的单个组），这些差异非常显著（P < 0.001）。与对照组相比，PM/DM组的柠檬酸盐、甘氨酸、含胆碱化合物和牛磺酸水平显著升高。CK活性与含胆碱化合物呈正相关（r = 0.78，P = 0.0006），与甜菜碱呈正相关（r = 0.57，P = 0.026）。这项研究表明，与对照组相比，PM/DM受试者的肌酸、含胆碱代谢物、甜菜碱和柠檬酸盐的尿水平存在显著差异，尽管需要进一步的工作来阐明潜在的代谢过程。
Background. A simple and reliable method is needed to assess disease activity and monitor the efficacy of therapy in polymyositis (PM) and dermatomyositis (DM). This study used in vitro proton (H-1) magnetic resonance spectroscopy (MRS) to explore whether excretion of urinary metabolites can be used as a reliable marker of disease in PM and DM patients.Methods. Urine samples were obtained from PM/DM patients (n = 34), healthy controls (50) and subjects with known muscle-wasting conditions including adult-onset muscular dystrophy (8), stroke patients (10), rheumatoid arthritis (RA) patients on steroids (13) and not on steroids (16) and patients with alcoholic myopathy (12). Levels of urinary metabolites were then correlated with creatine kinase (CK) activities and quadriceps; muscle strength.Results. Creatine was detected in the urine in 26 of 35 patients with PM/DM, four of 60 cases with other medical disorders (including one with adult-onset dystrophy, one with a stroke and two with RA who were not on steroids) and 10 of 50 healthy controls. The urinary creatine/creatinine ratio exceeded 0.4 in 20 patients with PM/DM but no patients with other medical disorders and no healthy controls. These differences were highly significant (P < 0.001) by Kruskal-Wallis test (comparing all groups) and by Mann-Whitney U-tests (comparing individual groups with PM/DM cases). Citrate, glycine, choline-containing compounds and taurine levels were significantly increased in PM/DM when compared with controls. There were positive correlations between CK activities and choline-containing compounds (r = 0.78, P = 0.0006) and also between CK activities and betaine (r = 0.57, P = 0.026).Conclusions. This study shows significant differences in the urinary levels of creatine, choline-containing metabolites, betaine and citrate in PM/DM subjects compared with controls, although further work is required to elucidate the underlying metabolic processes.