木村病的荟萃分析

发布时间：2018-04-13 23:13

本文选题：木村病 + 病理　；参考：《吉林大学》2017年硕士论文

【摘要】：背景:木村病(kimura’s disease,KD)是以长期存在并易反复的无痛性皮下软组织肿物为主要临床表现的一种病因尚未明确的慢性炎症性疾病。本病发病率低,临床较少见,近20年国内外相关病例报道仅近千例,好发于亚裔人群,且因木村病的临床表现缺乏特异性,临床上极易被漏诊、误诊。目前木村病常用的治疗方式包括手术切除、糖皮质激素治疗、化学治疗、局部放疗,但均易复发;而对联合治疗能否减少复发的研究较少,各学者在治疗方案的选择上尚有分歧。目的:通过分析相关文献报道,总结木村病的临床特点及诊治要点,并对比各治疗方案预后情况,从而加深临床医师对木村病的认识,减少误诊、漏诊的发生,并寻求最佳治疗方案,减少复发。方法:检索2000年1月至2017年3月为止公开发表的KD病例国内外文献,筛选相关病例。对入选病例的基本资料、临床表现、相关并发症、实验室检查、影像学检查、病理检查、治疗随访情况进行归纳总结。结果:筛选入组的297例经病理检查确诊为KD的患者中,男性244例,女性53例,男女比例4.6:1。发病年龄6个月—75岁,平均年龄34.2岁,病程1周至45年不等;其中亚裔人285例。297例患者就诊原因中以85.8%(254/297)无痛性头颈部皮下肿物为主;其中3.4%(10/297)并发肾病综合征。实验室检查中86.7%(196/226)外周血嗜酸性粒细胞升高;77.9%(74/95)患者血清Ig E水平升高;11.7%(16/137)尿蛋白检测呈阳性。经治疗达到部分缓解(PR)或完全缓解(CR)后,65.5%(19/29)血清Ig E水平降至正常范围,27.6%(8/29)降低50%以上;90.2%(37/41)外周血嗜酸性粒细胞降至正常水平。手术联合糖皮质激素治疗组与手术联合糖皮质激素、局部放疗组较单纯手术治疗组复发率明显降低;糖皮质激素治疗组复发率高于单纯手术治疗、局部放疗及联合治疗方案;局部放疗组与单纯手术治疗组复发率无明显差异,但低于糖皮质激素联合免疫抑制剂治疗组;单纯手术治疗组与糖皮质激素联合免疫抑制剂治疗组无明显差异。结论:1.对于头颈部无痛性皮下肿物的患者,应警惕木村病的可能;而木村病在诊断上主要依据其病理检查,结合其临床特点及实验室检查可确诊。2.外周血嗜酸性粒细胞及血清Ig E水平可成为木村病患者诊断、疗效、预后评估及随访监测的一项指标。3.木村病患者在诊治及随访过程中,应关注有无肾病综合征的相关临床表现并行相关检查,以期做到早期诊治。4.木村病治疗首选手术治疗,加用糖皮质激素治疗可减少术后复发;当患者无法行手术治疗时,推荐使用局部放疗;不建议单用糖皮质激素治疗,不建议糖皮质激素联合免疫抑制剂治疗。
[Abstract]:Background: kimura disease (KD) is a chronic inflammatory disease which is characterized by chronic painless subcutaneous soft tissue mass.The incidence of this disease is low, clinical is relatively rare, in recent 20 years domestic and foreign related cases reported only about 1000 cases, prone to occur in Asian people, and because of the lack of specificity of the clinical manifestations of Kimura disease, it is easy to be missed clinically, misdiagnosed.At present, the commonly used treatments for Kimura disease include surgical resection, glucocorticoid therapy, chemotherapeutic therapy, and local radiotherapy, but all of them are prone to relapse; however, there are few studies on whether combined therapy can reduce recurrence.There are still differences among scholars on the choice of treatment plan.Objective: to summarize the clinical characteristics, diagnosis and treatment of Kimura disease by analyzing the related literature, and to compare the prognosis of each treatment plan, so as to deepen the clinicians' understanding of the disease and reduce the occurrence of misdiagnosis and missed diagnosis.And to seek the best treatment to reduce recurrence.Methods: the literatures of KD cases published from January 2000 to March 2017 were searched and selected.The basic data, clinical manifestation, related complications, laboratory examination, imaging examination, pathological examination and treatment follow-up were summarized.Results: of 297 selected patients, 244 were male and 53 were female, the ratio of male to female was 4.6: 1.The onset age ranged from 6 months to 75 years with an average age of 34.2 years and the course of disease ranged from 1 week to 45 years.In laboratory examination, 86.7% of eosinophils in peripheral blood increased 77.9% and 74% of 95%) the level of serum IgE increased 11.7% 16 / 137) urinary protein was positive.After treatment, the level of serum IgE decreased to a normal range of 27.6% and 8 / 29) after treatment with partial remission (PR) or complete remission (CRR), the level of eosinophils in peripheral blood decreased to normal level by more than 50% (90.22 / 41).The recurrence rate of operation combined with glucocorticoid group and surgery combined with glucocorticoid group was significantly lower than that of simple operation group, and the recurrence rate of glucocorticoid group was higher than that of simple operation treatment group, local radiotherapy group and combined treatment plan.The recurrence rate of local radiotherapy group was not significantly different from that of simple operation group, but lower than that of glucocorticoid combined with immunosuppressant group, and there was no significant difference between simple operation group and glucocorticoid combined immunosuppressant group.Conclusion 1.Patients with painless subcutaneous masses of head and neck should be on guard against the possibility of Kimura disease, and the diagnosis of Kimura disease is mainly based on its pathological examination, combined with its clinical characteristics and laboratory examination can be diagnosed. 2.The levels of eosinophil and serum IgE in peripheral blood can be used as an index of diagnosis, curative effect, prognosis evaluation and follow-up monitoring in patients with Kimura disease.In the course of diagnosis, treatment and follow-up, the patients with Kimura disease should pay attention to the related clinical manifestations of nephrotic syndrome and correlation examination, in order to achieve early diagnosis and treatment. 4.The first choice for the treatment of Kimura disease is surgical treatment, and the addition of glucocorticoid therapy can reduce postoperative recurrence; when the patient cannot be treated with surgery, local radiotherapy is recommended; and only glucocorticoid therapy is not recommended.Glucocorticoid combined with immunosuppressant therapy is not recommended.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R597

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