以关节炎为首发表现的肥大性肺性骨关节病五例患者临床分析

发布时间：2018-03-24 21:46

本文选题：关节炎　切入点：肥大性肺性骨关节病　出处：《中国全科医学》2017年05期

【摘要】：目的探讨以关节炎为首发表现的肥大性肺性骨关节病(HPOA)的临床特点,以提高认识,减少误诊误治。方法回顾性分析2006—2015年北京积水潭医院诊治的5例以关节炎为首发表现的HPOA患者的临床资料,结合文献复习,总结其临床表现、实验室检查及影像学特点。结果临床资料:5例患者中,男4例、女1例,中位年龄51岁,中位病程6个月。5例均为多关节受累,且呈对称性,均有双侧下肢大关节受累(膝、踝关节)。3例有轻度咳嗽,4例有吸烟史。5例查体均可见杵状指(趾)。5例原发病均为肺癌。实验室检查:3例存在轻度贫血,4例红细胞沉降率(ESR)、C反应蛋白(CRP)水平升高,5例类风湿因子(RF)、抗环瓜氨酸肽(抗CCP)抗体、抗核抗体谱(ANAs)及人类白细胞抗原(HLA)-B27均阴性,4例肿瘤标志物水平升高。影像学:3例X线示双下肢(股骨、胫骨)对称性骨膜反应,4例骨显像示四肢长骨骨皮质放射性分布增高,5例肺CT发现占位性病变。结论以关节炎为首发表现的HPOA虽然少见,但对于中老年患者出现对称性以下肢为主的关节炎、伴杵状指(趾)、存在系统症状、抗风湿治疗效果不佳时应积极行X线及骨扫描检查,一旦诊断HPOA,尽早完善肺部影像学筛查恶性肿瘤。
[Abstract]:Objective to investigate the clinical features of hypertrophic pulmonary osteoarthropathy (HPOA) with arthritis as the first manifestation in order to improve the understanding of HPOA. Methods the clinical data of 5 patients with HPOA with arthritis as the first symptom were analyzed retrospectively from 2006 to 2015 in Beijing Jishuitan Hospital, and their clinical manifestations were summarized in combination with literature review. Results among the 5 patients, 4 were male and 1 female. The median age was 51 years old. The median course of disease was 6 months. 3 cases of ankle joint with mild cough 4 cases with smoking history 5 cases with clubbing finger (toe 5 cases with primary disease all lung cancer. Laboratory examination 3 cases with mild anemia 4 cases with erythrocyte sedimentation rate and 4 cases with erythrocyte sedimentation rate and the level of CRP5) increased. A case study of rheumatoid factor RFN, anti-cyclic citrullinated peptide (anti-CCPP) antibody, The level of tumor markers was increased in 4 patients with negative ANAS-ANASS and HLA-B27 HLA-B 27 antigens, and in 3 patients with X ray imaging, the lower extremities (femur, femur, femur, femur, femur) were detected by X-ray examination. The symmetrical periosteal reaction of tibia (n = 4) showed that the radioactivity distribution of the long bone cortex of the extremities was increased and 5 cases of pulmonary CT were found to have space-occupying lesions. Conclusion although the first manifestation of arthritis is HPOA, it is rare. But for the middle-aged and elderly patients with arthritis with symmetry of lower extremity and clubbing (toe) with systemic symptoms, X-ray and bone scan should be performed actively when the effect of anti-rheumatism treatment is not good. Once HPOA is diagnosed, improve lung imaging screening for malignant tumors as soon as possible.
【作者单位】：北京积水潭医院风湿免疫科;
【分类号】：R684.1

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