11例瘤源性骨软化症的临床诊治分析

Clinical diagnosis and treatment of tumor-induced osteomalacia: An analysis of 11 cases

目的分析瘤源性骨软化症（tumor—induced osteomalacia，TIO）的临床特征、诊断及治疗规律，提高对TIO的识别及早期诊治能力。方法我院2010年4月-2013年4月收治11例确诊TIO患者，分析其手术前、后临床症状及血生化变化情况。结果男性5例，女性6例；年龄19—54岁，平均37．7岁。发病到确诊的时间2—15年，平均5．5年。11例均有骨痛和肌无力症状，血磷低而尿磷高，血钙正常，碱性磷酸酶（alkaline phosphatase，ALP）升高。3例发现皮下软组织包块。8例行奥曲肽扫描（99m Tc—OCT）均提示有生长抑素受体高表达病变。11例手术治疗后均获得病理确诊，术后10例血磷恢复正常，所有患者骨痛及肌无力症状明显缓解。结论TIO临床症状典型，99m Tc—OCT及其他影像学检查有助于定位肿瘤。手术切除病灶后血磷可恢复正常，症状改善明显。

Objective To improve the clinical diagnosis and treatment level of tumor-induced osteomalacia （TIO） by analyzing the clinical features, diagnosis and treatment of 11 cases with TIO. Methods Clinical data （including clinical presentation, management, perioperative clinical status and biochemical changes） of 11 patients with TIO admitted to our hospital from April 2010 to April 2013 were retrospectively analyzed. Results There were 5 males and 6 females with an average age of 37.7 years （range 19-54 years）. The average time interval between onset and proven TIO was 5.5 years （range, 2-15 years）. All the 11 patients presented with bone pain and muscle weakness, hypophosphatemia, hyperphosphatemia, normal serum calcium and increased alkaline phosphatase （ALP）. Subcutaneous soft tissue mass was found in 3 cases, 99mTc-OCT was performed in another 8 cases and it showed high expression of somatostatin receptor on different lesions of different patients. All the patients were confirmed by histopathology after operation. Serum Pi levels returned to normal in 10 patients after resection of tumors, symptoms of bone pain and muscle weakness were all improved obviously. Conclusion TIO is an extremely rare acquired disease with typical clinical features. Identifying the responsible tumors is clinically essential for the treatment of TIO, 99mTc-OCT and other imaging examinations are also helpful to locate the tumors. After complete excision of the tumors, the patients＇ serum phosphate levels and clinical symptoms are greatly improved.