2015 年第 4 期 第 13 卷

副肿瘤风湿综合征28例临床分析并文献复习

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关键词：风湿症状，风湿病，肿瘤，副肿瘤风湿综合征

• 摘要：
• 【摘要】目的: 总结以风湿病症状为首发或突出表现的恶性肿瘤的临床特点，并结合文献复习风湿病与恶性肿瘤的相关性, 以减少该类恶性肿瘤的漏诊。方法:总结以风湿症状为突出表现的副肿瘤风湿综合征28 例，收集患者的临床资料, 分析其临床表现、辅助检查、拟诊风湿病类型和罹患肿瘤类型。结果:风湿症状以多关节肿痛、肌肉疼痛最为常见，抗核抗体阳性率为28.6%，类风湿因子阳性率为14.3% ，抗体滴度均较低且未见特异性抗体。28 例副肿瘤风湿综合征患者中可见到多种风湿病表现, 初次诊断以骨关节炎（8例）和骨质疏松（5例）居多。罹患肿瘤中以血液系统肿瘤为主, 为15 例(53.6% ), 实体瘤共13 例(46.4% )。结论:多种恶性肿瘤可出现风湿病表现, 对于风湿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，副肿瘤风湿综合征可为隐匿性癌提供早期诊断的临床线索。
• 0bjective：To improve awareness that rheumatic diseases probably associated with malignant tumors and to aviod misdiagnosis,we summarize the clinical features of paraneoplastic rheumatic syndromes .Methods : Totally 28 patients with rheumatic symptoms were finally diagnosed as malignant tumor were admitted, their clinical manifestations and diagnosis were analyzed. Resultands: Joint and muscle pain is the most common .The positive rate of anti nuclear antibody was 28.6%, the positive rate of rheumatoid factor was 14.3% ,but the antibody titers were lower and there is no specific antibodies in malignant tumors. A wide variety of rheumatic manifestations were present, the most often initial diagnosis were osteoarthritis (8) and osteoporosis (5) .The associated tumors were blood system tumors in 15 (53.6%), and solid tumors 13 (46.4%).Conclusions ：Malignant tumors may occurs for rheumatic manifestations. Patients with unexplained clinical manifestations, Poor efficacy for treatment should also be alert to the possibility of malignant tumor even though there are positive antibody. Paraneoplastic rheumatic syndromes can provide clinical clues for early diagnosis of occult cancer.