2016 年第 1 期 第 14 卷

风湿性疾病合并恶性肿瘤临床分析及文献复习

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关键词：风湿症状风湿性疾病肿瘤

• 摘要：
• 【摘要】目的: 探讨风湿性疾病合并恶性肿瘤的临床特点，并结合文献复习风湿性疾病与恶性肿瘤的相关性, 以提高对此类疾病的认识。方法: 回顾性分析15例诊断风湿性疾病合并恶性肿瘤患者的临床资料, 分析其临床表现、辅助检查、拟诊风湿性疾病类型和罹患肿瘤类型。结果:风湿症状以多关节肿痛、肌肉疼痛、皮疹最为常见，抗核抗体阳性率为60.0%，类风湿因子阳性率为46.6%。15例并发恶性肿瘤的风湿性疾病中，合并肿瘤10种共16例次。原发风湿性疾病为多发性肌炎/皮肌炎（PM/DM）、原发性干燥综合征（pSS）及系统性红斑狼疮（SLE）各3例，类风湿关节炎（RA）2例、风湿性多肌痛（PMR）、缓和性对称性血清阴性滑膜炎伴可凹性水肿（RS3PE）、成人still病各1例；罹患肿瘤中血液系统肿瘤6例(37.5%),实体瘤共10 例(62.5% )。结论:风湿性疾病合并恶性肿瘤风险增加，对于风湿性疾病难以解释的临床表现、常规治疗效果差者, 即使有抗体阳性，也要警惕恶性肿瘤的可能，风湿性疾病患者应注重随诊及肿瘤筛查。
• 0bjective：To improve awareness that rheumatic diseases probably associated with malignant tumors and to aviod misdiagnosis,we summarize the clinical features of rheumatic diseases complicated with malignant tumor- s.Methods :Totally 15 rheumatic diseases complicated with malignant tumor patients were admitted, their clinical manifestation and diagnosis were analyzed. Resultands: Joint muscle pain and rash are the most common Clinical features.The positive rate of anti nuclear antibody was 60.0%, the positive rate of rheumatoid factor was 46.6%, There were10 kinds of /16 cases of tumors complicated with 15 rheumatic diseases.A wide variety of rheumatic manifestations were present, 2 patients were diagnosed as dermatomyositis, and polymyositis 1， Sjogren syndrome 3， systemic lupus erythematosus 3, rheumatoid arthritis 2, polymyalgia rheumatica 1, remitting seronegative symmetrical synovitis with pitting edema (RS3PE)1，Adult Still's disease 1.6 (37.5%) were diagnosed as blood system tumors, and 10 (62.5%) solid tumors.Conclusions ：Rheumatic diseases associated with increased risk of malignancy, patients with unexplained clinical manifestations, Poor efficacy for routining treatment should also be alert to the possibility of malignant tumor even though there are positive antibody. patients with rheumatic disease should be long followed-up and screen of tumor when some findings suggest the presence of malignancy.