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目的:探讨实体肿瘤与血液肿瘤相关副肿瘤风湿综合征患者间的临床特点及长期预后差异,以提高对该类疾病的认识。方法:回顾性分析82例最终诊断为副肿瘤风湿综合征患者的临床资料及预后情况,将其分为实体肿瘤及血液肿瘤2组,比较组间的临床特点差异,并运用Kaplan-Meier方法进行生存分析,并采用Cox回归模型进行多因素分析。结果:实体肿瘤组与血液肿瘤组在发病年龄、性别比、起病至诊断肿瘤时间、红细胞沉降率(erythrocyte sedimentation tate,ESR)、C反应蛋白(C-reactionprotein,CRP)等方面差异均无统计学意义(P>0.05),而2组在ANA阳性率及肿瘤标志物升高率方面差异有统计学意义(P<0.05)。实体肿瘤拟诊风湿病最多的为炎症性肌病,而血液肿瘤拟诊的风湿病最多的为关节炎。血液肿瘤患者的生存时间长于实体肿瘤患者,2组间生存曲线差异有统计学意义(P=0.007)。Cox回归分析结果显示,淋巴结转移、起病至诊断肿瘤时间是影响实体肿瘤预后的独立危险因素。结论 :实体肿瘤与血液肿瘤相关副肿瘤风湿综合征患者间的部分临床特点及长期预后有差异。
Objective: To explore the clinical features and long-term prognosis differences between solid tumor and hematological tumor-associated paraneoplastic rheumatism syndrome in order to improve the understanding of such diseases. Methods: The clinical data and prognosis of 82 patients diagnosed as paraneoplastic rheumatic syndrome were retrospectively analyzed. The clinical data and prognosis were divided into two groups: solid tumors and hematological tumors. The clinical characteristics of the patients were compared and analyzed by Kaplan-Meier method Survival analysis and multivariate analysis using Cox regression model. Results: There was no statistical difference between the solid tumor group and the hematological tumor group in onset age, sex ratio, onset to diagnosis of tumor time, erythrocyte sedimentation rate (ESR) and C-reaction protein (CRP) (P> 0.05), while there was a significant difference between the two groups in the positive rate of ANA and the rate of tumor marker increase (P <0.05). Rheumatoid arthritis is the most frequently diagnosed rheumatic disease in solid tumors. Survival of patients with hematological malignancies was longer than that of solid tumors, and there was significant difference in survival curves between the two groups (P = 0.007). Cox regression analysis showed that lymph node metastasis, onset to diagnosis of tumor time is an independent risk factor affecting the prognosis of solid tumors. Conclusion: Some clinical features and long-term prognosis of solid tumor and hematological tumor-associated paraneoplastic rheumatic syndrome patients are different.