28例副肿瘤风湿综合征的临床分析及文献复习

目的：探究风湿病与恶性肿瘤的相关性，以减少伴风湿病的恶性肿瘤的漏诊。方法选取以风湿症状为突出表现的副肿瘤风湿综合征患者28例，收集患者的临床资料，并分析其临床表现、实验室检查及影像学检查结果、拟诊风湿性疾病类型和原发肿瘤类型。结果风湿症状以多关节肿痛、肌肉疼痛最为常见，抗核抗体阳性率为28.6%，抗体滴度均较低且未见特异性抗体，类风湿因子阳性率为14.3%。28例副肿瘤风湿综合征患者中可见到多种风湿病表现，初次诊断以骨关节炎（8例）和骨质疏松（5例）居多，骨质增生、皮肌炎、系统性红斑狼疮、类风湿关节炎、干燥综合征各2例，硬皮病、风湿性多肌痛、缓和性对称性血清阴性滑膜炎伴可凹性水肿、纤维肌痛综合征及痛风各1例。罹患肿瘤中以血液系统肿瘤为主，为15例（53.6%），实体瘤共13例（46.4%）。结论多种恶性肿瘤可出现风湿病表现，对于风湿病难以解释的临床表现、常规治疗效果差者，即使有抗体阳性，也要警惕恶性肿瘤的可能，副肿瘤风湿综合征可为隐匿性肿瘤提供早期诊断的临床线索。

Clinical analysis of 28 cases of paraneoplastic rheumatic syndromes and a review of literatures

Objective To investigate the probable association between rheumatic diseases and malignant tumors, improving the diagnosis of the disease. Method A total of 28 patients with manifest rheumatic symptoms that were finally diagnosed as malignant tumor were admitted, their clinical manifestations, laboratory tests, imaging findings and diagnosis regarding suspected rheumatic disease and primary tumor type were analyzed. Result Joint and mus-cle pain was the most common symptom. The positive rate of anti nuclear antibody was 28.6%, the positive rate of rheumatoid factor was 14.3%, but the antibody titers were generally low and there was no specific antibodies in ma-lignant tumors. A wide variety of rheumatic manifestations were present, the most common initial diagnosis were os-teoarthritis (8 cases) and osteoporosis (5 cases), followed by 2 cases each of hyperosteogeny, dermatomyositis and systemic lupus, rheumatoid arthritis, and Sjogren syndrome, then there was 1 case each of scleroderma, rheumatic polymyalgia, remitting seronegative symmetrical synovitis with pitting edema (RS3PE), fibromyalgia syndrome and gout. The predominant tumors were hematological cancers in 15 (53.6%), and solid tumors in 13 (46.4%). Conclusion Malignant tumors may have rheumatic manifestations. Patients with unexplained clinical manifestations, poor effica-cy for treatment should also be alert to the possibility of malignant tumor even though there is positive antibody. Paraneoplastic rheumatic syndromes imply considerable clinical clues for early diagnosis of occult cancer.