多发性肌炎与皮肌炎合并恶性肿瘤14例临床分析

Analysis on 14 cases of dermatomyositis and polymyositis associated with malignancy

目的探究多发性肌炎(PM)/皮肌炎(DM)合并恶性肿瘤的临床特征及相关因素,以利早期诊断、干预,提高患者生存率。方法收集我院近4年收治的117例PM/DM患者资料进行比较分析总结。结果①PM/DM伴发恶性肿瘤患者(14例)年龄较PM/DM不伴发恶性肿瘤患者(103例)大(t=2.493,P<0.05),两组性别、病程差异无统计学意义;②PM/DM伴发恶性肿瘤患者的典型皮疹,如眶周皮疹、颈胸部V型皮疹、Gottron征症状发生率明显高于不伴发恶性肿瘤患者(P均<0.01),而关节炎发生率低于不伴发恶性肿瘤患者(P<0.05);③PM/DM伴发恶性肿瘤患者红细胞沉降率(ESR)升高水平高于不伴发恶性肿瘤患者(Z=-2.809,P<0.01),免疫球蛋白(GLOB)水平低于不伴发恶性肿瘤患者(Z=-2.9149,P<0.01)。结论 PM/DM容易合并恶性肿瘤,常见于高龄,伴发典型皮疹、ESR水平升高、GLOB水平降低的无关节受累患者,对表现上述症状及血清学结果的PM/DM患者需进行恶性肿瘤筛查。

Objective To investigate the clinical features and related factors of polymyositis(PM)and dermatomyositis(DM)combined with malignancy in order to make the early diagnosis and intervene the disease,and improve survival rate of PM/DM patients.Methods The data of 117 PM/DM patients admitted to the hospital in the past 4 years were collected and compared.Results①PM/DM patients with malignant tumors(14 cases)were older than those with PM/DM without malignant tumors(103 cases)(t=2.493,P<0.05)(t=2.493,P<0.05).There was no significant difference in the incidence,sex and duration of PM and DM malignant tumors between the two groups;②The incident of model skin rash such as Heliotrop rash,V-shaped rash in the neck and chest area and Gottron sign in malignancy group were all higher than that of non-malignancy group(P<0.01),and the incidence of arthritis was lower than non-malignancy group(P<0.05);③The elevated ESR in malignancy group was higher than non-malignancy group(Z=-2.809,P<0.01),but GLOB was lower than that of non-malignancy group(Z=-2.9149,P<0.01).Conclusion PM/DM is easy to be associated with malignancy,which is common in elderly patients with the model skin rash,elevated ESR,lower GLOB and without arthritis.Therefore,PM/DM patients who present the above symptoms and serologic results should be screened for malignant tumors closely.