胸腺瘤合并系统性红斑狼疮九例临床分析

Clinical analysis of 9 cases of thymoma in sy stemic lupus erythematosus

目的：胸腺瘤常合并自身免疫病，回顾性分析胸腺瘤合并SLE患者的临床特点。方法全部病例是山东大学齐鲁医院2004年6月至2014年6月住院患者，均符合ACR 1997年SLE分类标准。胸腺瘤是在胸部CT时被发现。结果 SLE合并胸腺瘤共9例。9例患者中男∶女=1∶8，SLE发病年龄为（48±19）岁，发现胸腺瘤时的年龄为（47±19）岁。随访3～10年无变化。其中3例手术切除组织病理学证明为良性胸腺瘤。1例（11%）患SLE 9年后发现胸腺瘤，5例（56%）同时发现SLE和胸腺瘤，3例（33%）在胸腺瘤切除后发生SLE。 SLE的临床表现包括皮肤损害4例（44%），多关节炎8例（89%），肾脏受累5例（56%），外周血白细胞减少3例（33%），血小板减少3例（33%），间质性肺炎2例（22%），胸浆膜腔积液或胸膜肥厚4例（44%）；无神经精神性狼疮。9例患者（100%） ANA均为阳性，7例（78%）抗dsDNA抗体阳性。结论合并胸腺瘤的SLE患者其发病年龄偏大，可以出现SLE相关的多系统损害，抗dsDNA抗体阳性率较高。

Objective Thymoma is associated with autoimmune diseases. We retrospectively analyzed the clinical characteristics of thymoma complicated systemic lupus erythematosus （SLE）. Methods Patients were from Qilu Hospital Shandong University between June 2004 and June 2014, and satisfied classification criteria of American College of Rheumatology （ACR） classification criteria 1997 for SLE. Thymoma was diagnosed by chest CT scan. Results Nine cases were of thymoma complicated with SLE, with the male：female ratio of 1∶8. The age of SLE onset was （48±19） years, age of thymoma discovery was （47±19） years. The follow-up period was 3 to 10 years. Three cases （33%） were benign thymoma and underwent thymectomy and verified by histopa-thology test. One case presented thymoma 9 years after SLE, 5 cases （56%） presented SLE and thymoma simultaneously, 3 cases （33%） presented SLE after thymectomy. Clinical manifestations of SLE included 4（44%） skin lesions, 8（89%） polyarthritis, 5（56%） nephritis, 3（33%） leukocytopenia, 3（33%） throm-bocytopenia, 2 （22%） of interstitial pneumonia, 4 （44%） pleural effusion, no neuropsychiatric systemic lupus erythematosus. Nine cases （100%） were ANA positive, 7 （78%） were anti-dsDNA positive. Conclusion SLE complicated thymoma usually occurs in relatively older age, tend to present with multi-systemic presentations, and high percentage of anti-dsDNA positivity.