合并恶性肿瘤的类风湿关节炎74例

doi:10.19723/j.issn.1671-167X.2018.06.008

摘要/Abstract

摘要：

目的: 对合并恶性肿瘤的类风湿关节炎患者74例的临床特征进行分析。方法: 回顾总结首都医科大学附属北京世纪坛医院2011年1月至2017年6月住院治疗的1 562例类风湿关节炎患者,对其中74例类风湿关节炎合并恶性肿瘤的患者的一般情况、所患肿瘤类型、类风湿关节炎和肿瘤起病顺序、用药情况等进行分析。结果: 类风湿关节炎患者恶性肿瘤的发病率为4.16%,74例患者中女性53例,男性21例。类风湿关节炎发病时年龄(52.6 ± 17.8) 岁,肿瘤确诊时年龄(63.4±12.7)岁。类风湿关节炎起病时间早于恶性肿瘤者51例(51/74),时间间隔2~60年,平均(17.2±14.2)年;恶性肿瘤发病早于类风湿关节炎者16例(16/74),时间间隔1~21年,平均(6.2±5.9)年,其中10例为性激素相关的肿瘤;二者同时发病7例(7/74),两者发生时间间隔在1年以内,7例均为RA先诊断,年龄均在60岁以上,且均为消化道肿瘤。肿瘤类型以胃肠道肿瘤、乳腺癌和生殖系统肿瘤最常见;其次为呼吸系统肿瘤、泌尿系统肿瘤和血液系统肿瘤。结论: 类风湿关节炎患者合并恶性肿瘤的风险增加,病情活动、药物的使用、雌激素及吸烟等是可能的危险因素,因此所有类风湿关节炎患者在诊断时均要进行恶性肿瘤筛查,诊断后要进行恶性肿瘤监测。

关键词: 类风湿关节炎, 恶性肿瘤, 恶性肿瘤监测

Abstract:

Objective: To investigate the clinical characteristics of rheumatoid arthritis (RA) patients with malignant tumor.Methods:Retrospective summary was made of 1 562 in patients of RA from January 2011 to June 2017.In the study, 74 RA patients with malignant tumor were reviewed and analyzed, and the general conditions, tumor types, RA and tumor onset sequence, and the medication situation were analyzed.Results:The incidence of malignant tumor in the patients with rheumatoid arthritis in our center was 4.16 %. The 74 patients were complicated with malignant tumor, of whom 53 were female,and 21 male. The age of RA at presentation was (52.6±17.8) years. The average disease duration of malignant tumor was (63.4 ± 12.7) years. The onset time of rheumatoid arthritis was earlier than that of malignant tumors in 51 cases (51/74), with an average of (17.2±14.2) years between 2 and 60 years. The incidence of malignant tumor was earlier than that of rheumatoid arthritis in 16 cases (16/74), with an average of (6.2±5.9) years between 1 and 21 years, of which 10 cases were sex hormone related tumors. Seven cases (7/74) were diagnosed with RA at the same time, and the time interval between the two diseases was within 1 year. All the patients were over 60 years old with digestive tract tumors. All the 7 patients showed polyarthritis, significantly increased erythrocyte sedimentation rate and C-reactive protein, including 4 rheumatoid factor positive cases and 2 anti-CCP antibody positive cases. The effect of non-steroidal anti-inflammatory drugs and traditional drugs to improve the condition of the disease was poor in the 7 patients, and the condition was relieved after using low-dose glucocorticoids. Gastrointestinal tumors, breast and reproductive system tumors were the most common, followed by respiratory, urological and blood system tumors.Conclusion:The risk in patients of rheumatoid arthritis complicated with malignant tumor is higher than that of the general population. A variety of factors play an important role in cancer risk of RA, including disease activity, some estrogen metabolites, the use of drugs and so on. Therefore, all RA patients should be screened for malignant tumor during diagnosis, and malignant tumor surveillance is mandatory for all rheumatoid arthritis patients after diagnosis.

Key words: Rheumatoid arthritis, Malignant tumor, Malignant tumor surveillance

中图分类号:

R593.22

王玉华,张国华,张令令,罗俊丽,高兰,赵绵松. 合并恶性肿瘤的类风湿关节炎74例[J]. 北京大学学报（医学版）, 2018, 50(6): 986-990.

Yu-hua WANG,Guo-hua ZHANG,Ling-ling ZHANG,Jun-li LUO,Lan GAO,Mian-song ZHAO. Clinical characteristic of 74 cases of malignant tumor in rheumatoid arthritis[J]. Journal of Peking University(Health Sciences), 2018, 50(6): 986-990.

图/表 2

表1

类风湿关节炎合并恶性肿瘤的主要资料"

Tumor site	Case	Tumor diagnosis age/years, $x -$ ±s	RA diagnosis age/years, $x -$ ±s	Smoking history, n	Tumor onset before/ concurring with/after RA onset
Breast	17	61.6±12.8	59.6±10.4	0	8/0/9
Colorectal	10	64.3±12.7	58.8±19.6	5	4/0/6
Lung	9	73.3±10.1	52.0±21.9	3	0/0/9
Esophagus	5	63.2±7.3	45.2±9.4	1	0/1/4
Lymphoma	5	65.8±14.1	53.6±24.9	0	1/0/4
Prostate	4	73.3±3.4	69.5±7.5	2	1/1/2
Endometrium	3	38.3±27.0	53.3±12.7	0	1/0/2
Pancreas	3	69.3±5.5	62.7±7.1	1	0/2/1
Thyroid	3	44.7±1.5	26.7±3.8	0	0/0/3
Stomach	2	69.0±14.1	47.5±16.3	0	0/1/1
Liver	2	76.0±8.5	57.5±21.9	1	0/0/2
Ovary	2	49.0±12.7	22.0±14.1	0	0/0/2
Biliary duct	1	64	63	0	0/1/0
Cholecyst	1	59	59	0	0/1/0
Periampullar	1	57	32	0	0/0/1
Meninges	1	57	47	0	0/0/1
Glioblastoma	1	61	44	0	0/0/1
Cervical	1	50	37	0	0/0/1
Peritoneal	1	74	55	0	0/0/1
Kidney	1	59	53	0	0/0/1
Testis	1	31	41	1	1/0/0

表1

表2

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General information	RA onset before tumor	RA and tumor occured simultaneously	RA onset after tumor
Number of cases	51	7	16
Male :female	14 :37	3 :4	4 :12
Time interval/years	17.2±14.2	0.5±0.3	6.2±5.9
Tumor types and case number	Breast/lung 9, colorectal 6, esophagus/lymphoma 4, thyroid 3, prostate/endometrium/liver/ovary 2, pancreas/stomach/periampul- lar/meninges/glioblastoma/cer-vical/peritoneal 1	Pancreas 2, esophagus/prostate/ stomach/biliary duct/cholecyst 1	Breast 8, colorectal 4, lymphoma/ prostate/endometrium/testis 1