皮肌炎和多发性肌炎伴发肿瘤临床特点及文献回顾

Clinical Features of Dermatomyositis and Polymyositis Associated with Tumors with Literature Review

目的比较皮肌炎(DM)、多发性肌炎(PM)合并肿瘤与未合并肿瘤患者的临床特点,寻找可能的危险因素。方法对北京协和医院2007至2012年诊断DM或PM合并肿瘤患者的临床资料进行回顾性分析,对DM或PM合并肿瘤与同期未合并肿瘤患者的临床表现、实验室检查、转归进行比较。检索近10年的炎性肌病合并肿瘤的中文文献,并进行回顾性分析。将文献资料结合本文病例进行描述性分析。结果北京协和医院2007年至2012年DM或PM合并肿瘤患者30例;2007年至2008年DM或PM患者105例,其中5例伴发恶性肿瘤,均为女性,DM4例、重叠综合征1例(DM合并SLE)。DM或PM合并恶性肿瘤患者的肺间质病变发生率低于未合并恶性肿瘤组(P=0.022)。中文文献及本文病例694例患者中,合并鼻咽癌的DM或PM患者最多(30.26%)。结论对于年龄偏大的炎性肌病患者,尤其不伴有肺间质病变及典型抗体的患者,应积极筛查肿瘤。鼻咽癌是DM或PM患者最常见的肿瘤类型,推荐对DM或PM患者行鼻咽部内镜检查提高肿瘤检出率。

Objective To compare the clinical features of DM/PM patients associated with tumors and those without tumors and investigate for the possible risk factors related. Methods The clinical data of inpatients diagnosed with DM/PM during 2007 to 2012 in Peking Union Medical College Hospital （PUMCH） were included. The clinical manifestations, laboratory tests, treatment and outcomes were compared between patients associated with tumors and those without tumors. Chinese literature of the recent 10 years were reviewed and descriptive statistics were used to analyze the data. Results From 2007 to 2008, 105 DM/PM patients in PUMCH were diagnosed and 5 patients were associated with malignant tumors （0 male, 5 females）. In patients with tumors, 4 patients were diagnosed with DM and 1 was diagnosed with overlap （DM and SLE ） syndrome. The difference of the prevalence of interstitial lung disease was statistically significant（P = 0. 022）. The literature review had shown that nasopharyngeal carcinoma was the most common type of tumor （ 30. 26% ）. Conclusion Older patients with DM/PM, particularly those without interstitisal lung disease or typical antibodies, should be screened aggressively for tumors. Nasopharyngealcarcinoma is the most common type of tumor in DM/PM patients, so fiberoptic endoscopy is recommend as the routine test for DM/PM patients to improve tumor detection rate.