胰腺炎、脂膜炎和关节炎三联征临床分析

目的 分析胰腺炎、脂膜炎和关节炎三联征（PPP综合征）临床特点。 方法 报道2013年7月PPP综合征1例，回顾国内外报道的33例PPP综合征的临床资料。 结果 该例患者以脂膜炎、关节炎为首发表现，尽管胰酶升高，但是腹部症状轻微。34例患者中，70.6% （24/34） 腹部体征轻微甚至完全缺乏，容易误诊。多关节受累多见，约1/3患者关节炎症状先于诊断胰腺疾病之前发生，对非甾体抗炎药（NSAID）和（或）激素反应较差。脂膜炎病理活检发现特征性“鬼影细胞”。10例患者死于胰腺疾病并发症（包括2例肿瘤），病死率高达29.4%（10/34）。 结论 PPP综合征腹部症状轻微，病死率高，应采取针对胰腺疾病的治疗方案，防止误诊、误治。

Clinical Analysis of Pancreatitis,Panniculitis, and Polyarthritis Syndrome

Objective To investigate the clinical characteristics of pancreatitis, panniculitis, and polyarthritis syndrome （PPP syndrome）. Methods A patient with PPP syndrome in July 2013 was reported. The clinical features of 33 cases of PPP syndrome at home and abroad were reviewed. Results Our patient with panniculitis and arthritis as the first manifestation had few abdominal symptoms despite high serum levels of pancreatic enzymes. In the 34 PPP cases, 70.6% （24/34） had absent or mild abdominal symptoms, easily leading to misdiagnosis. Multi-joint involvement was more common, and in almost 1/3 of the patients, joint symptoms with poor NSAIDs and/or hormonal responses predated the identification of pancreatic disease. Parmiculitis biopsy found characteristic ＂ghost cells＂. Ten patients died of complications of pancreatic disease （including 2 cases of cancer）, and the mortality rate was as high as 29.4% （10/34）. Conclusion PPP syndrome with mild abdominal symptoms and high mortality should be taken for the treatment of pancreatic disease, to prevent misdiagnosis and mistreatment.