本文選題：關節(jié)炎　切入點：肥大性肺性骨關節(jié)病　出處：《中國全科醫(yī)學》2017年05期

【摘要】：目的探討以關節(jié)炎為首發(fā)表現的肥大性肺性骨關節(jié)病(HPOA)的臨床特點,以提高認識,減少誤診誤治。方法回顧性分析2006—2015年北京積水潭醫(yī)院診治的5例以關節(jié)炎為首發(fā)表現的HPOA患者的臨床資料,結合文獻復習,總結其臨床表現、實驗室檢查及影像學特點。結果臨床資料:5例患者中,男4例、女1例,中位年齡51歲,中位病程6個月。5例均為多關節(jié)受累,且呈對稱性,均有雙側下肢大關節(jié)受累(膝、踝關節(jié))。3例有輕度咳嗽,4例有吸煙史。5例查體均可見杵狀指(趾)。5例原發(fā)病均為肺癌。實驗室檢查:3例存在輕度貧血,4例紅細胞沉降率(ESR)、C反應蛋白(CRP)水平升高,5例類風濕因子(RF)、抗環(huán)瓜氨酸肽(抗CCP)抗體、抗核抗體譜(ANAs)及人類白細胞抗原(HLA)-B27均陰性,4例腫瘤標志物水平升高。影像學:3例X線示雙下肢(股骨、脛骨)對稱性骨膜反應,4例骨顯像示四肢長骨骨皮質放射性分布增高,5例肺CT發(fā)現占位性病變。結論以關節(jié)炎為首發(fā)表現的HPOA雖然少見,但對于中老年患者出現對稱性以下肢為主的關節(jié)炎、伴杵狀指(趾)、存在系統(tǒng)癥狀、抗風濕治療效果不佳時應積極行X線及骨掃描檢查,一旦診斷HPOA,盡早完善肺部影像學篩查惡性腫瘤。
[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.
【作者單位】： 北京積水潭醫(yī)院風濕免疫科;
【分類號】：R684.1

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