协和医学杂志

2015, v.6(01) 24-28

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多发性肌炎合并恶性肿瘤10例临床特点
Clinical Characteristics of 10 Cases with Polymyositis and Malignancy

徐娜;焦洋;曾学军;张奉春;
X Na;JIAO Yang;ZENG Xue-jun;ZHANG Feng-chun;Department of General Internal Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Rheumatology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

目的总结多发性肌炎(polymyositis,PM)合并恶性肿瘤患者的临床特点。方法回顾性分析1989年10月至2013年6月在北京协和医院住院的PM合并恶性肿瘤患者的临床资料,总结其临床特点。结果 PM合并恶性肿瘤患者共10例,占同期PM住院患者的2.4%(10/424)。其中男3例,女7例,中位年龄57岁。所有患者均有四肢近端肌无力;抬头困难、饮水呛咳、声音嘶哑各1例。出现肺间质病变5例、呼吸肌受累2例、心脏受累6例。肿瘤类型以淋巴瘤和肺癌常见(各3例),其他包括食管癌、胃癌、肾癌、宫颈癌(各1例)。7例患者在PM诊断前后1年内发现肿瘤,肿瘤首发表现包括淋巴结肿大、咳嗽气短、吞咽困难、肉眼血尿、绝经后阴道流血,3例无症状患者筛查发现便潜血阳性或肺占位。9例接受足量激素治疗,5例PM在1个月内完全缓解;4例仅部分缓解,其中3例在肿瘤治疗后完全缓解。结论由于合并恶性肿瘤可影响PM的治疗反应和预后,临床应高度警惕。对于PM合并肿瘤患者,应及早进行肿瘤治疗以更好地改善症状和控制病情。
Objective To summarize the clinical features of patients with polymyositis and malignancy.Methods We retrospectively reviewed the clinical records of patients with polymyositis and malignancy hospitalized at Peking Union Medical College Hospital from October 1989 to June 2013. Results Malignancy was identified in 2. 4%( 10 /424) of patients with polymyositis in the hospital during the studied period. The median age of the 10 patients( 3 males and 7 females) was 57 years. All patients had significant proximal muscle weakness. Difficulty in head-lifting,bucking,and hoarseness were each observed in one case. Interstitial lung disease,respiratory muscle involvement,and cardiac involvement were observed in 5,2,and 6 patients,respectively. The most common types of cancer were lymphoma and lung cancer( 3 cases each). Other types included esophageal,gastric,renal,and cervical cancers( 1 case each). Malignancies in 7 cases were discovered within 1 year before or after polymyositis diagnosis. The initial demonstrations of malignancies included lymphadenectasis,cough and dyspnea,dysphagia,gross hematuria,and postmenopausal vaginal bleeding. Three asymptomatic patients were identified through screening based on positive feces occult blood test or lung mass. Five out of the 9 patients receiving adequate dose of glucocorticoid recovered completely from polymyositis within 1 month,whereas the remaining 4 patients improved but did not fully recover. Of the 4 patients,3 patients achieved complete recovery after treatment for cancer. Conclusions Malignancy may interfere with the treatment response and prognosis of polymyositis,there-fore patients with polymyositis should have a complete screening for the underlying malignancy. Early cancer treatment should be prescribed to better mitigate symptoms and manage conditions in patients with polymyositis and cancer.

关键词(KeyWords): 多发性肌炎;恶性肿瘤
polymyositis;malignancy

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作者(Author): 徐娜;焦洋;曾学军;张奉春;
X Na;JIAO Yang;ZENG Xue-jun;ZHANG Feng-chun;Department of General Internal Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Rheumatology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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