风湿性疾病合并恶性肿瘤15例临床分析及文献复习

Clinical analysis of rheumatic diseases complicated with malignant tumor and a review of literatures

目的探讨风湿性疾病合并恶性肿瘤的临床特点。方法收集15例风湿性疾病合并恶性肿瘤患者的临床资料,结合文献分析风湿性疾病与恶性肿瘤的相关性。结果 15例合并恶性肿瘤的风湿性疾病患者合并肿瘤10种共16例次,均为风湿病发病时或发病后发现;原发风湿性疾病为多发性肌炎/皮肌炎、原发性干燥综合征及系统性红斑狼疮各3例,类风湿关节炎2例;罹患血液系统肿瘤6例(37.5%),实体瘤10例(62.5%)。合并肿瘤患者的风湿症状以关节肿痛、肌肉疼痛、皮疹最为常见;实验室检查抗核抗体阳性9例(60.0%),类风湿因子升高7例(46.6%),ESR升高11例(73.3%),其中ESR大于100 mm/h者5例,CRP升高10例(66.7%),肿瘤标志物升高10例(66.7%)。结论对有难以解释的临床表现及常规治疗效果差的风湿性疾病患者,要警惕恶性肿瘤的可能,并注重随诊及肿瘤筛查。

Objective To investigate the clinical characteristics of patients with rheumatic diseases complicated with malignant tumors. Methods Totally 15 rheumatic diseases complicated with malignant tumor patients were admitted, their clinical manifestation and diagnosis were analyzed. Results 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 were l 0 kinds of/16 cases of tumors complicated with 15 rheumatic diseases. A wide variety of rheumatic manifes- tations were present, 2 patients were diagnosed as dermatomyositis（DM）, and polymyositis（PM） 1, primary Sjogren syndrome（pSS） 3, systemic lupus erythematosus （SLE） 3, rheumatoid arthritis（RA） 2, systemic sclerosis（SSc）l ,polymyalgia rheumatica （PMR） 1, remitting seronegative symmetrical synovitis with pitting edema （RS3PE）I, 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.