缓解性血清阴性的对称性滑膜炎伴可凹陷性水肿综合征21例分析  

Remitted seronegative symmetrical synovitis with pitting edema syndrome:clinical analysis of 21 cases

作　　者：郭惠芳[1] 于庆海 刘凤珍[1] 邵福灵[1] 

机构地区：[1]河北医科大学第二医院免疫风湿科,石家庄市050000 [2]河北省承德市平泉县县医院

出　　处：《中华老年医学杂志》2005年第5期345-347,共3页Chinese Journal of Geriatrics

摘　　要：目的进一步了解缓解性血清阴性的对称性滑膜炎伴可凹陷性水肿(RS3PE)综合征的临床和实验室特点,减少漏诊和误诊.方法回顾性分析21例RS3PE综合征患者的临床资料,包括症状、体征、实验室检查及疗效,并复习相关文献.结果21例患者中男性18例,年龄57～81岁,平均69.2岁,其中≥60岁19例.均表现为突发双手、足背凹陷性水肿及多关节炎,近端指间关节炎和掌指关节炎各17例(各81.0%),腕关节炎12例(57.0%),膝关节炎和踝关节炎各8例(各38%)、肘关节炎4例(19.0%).14例外周血白细胞(10.0～14.3)×109/L,血沉平均(90±38)mm/1 h,C反应蛋白平均(836±122)μg/L,1例抗核抗体1:40阳性,其余均阴性,类风湿因子、抗可提取核抗原抗体及抗双链DNA抗体、人类白细胞相关抗原B27均阴性.21例患者手足、骶髂关节X线均未见异常.8例合并恶性肿瘤,7例死于肿瘤转移.1例合并急性肾盂肾炎和反应性噬血细胞综合征.小剂量泼尼松和慢反应药治疗后临床症状缓解,但合并肿瘤者易复发,手术或化疗后缓解.合并感染者经抗感染治疗未再复发.结论RS3PE综合征是异质性临床症候群,小剂量泼尼松和慢反应药物治疗有效,但该病与风湿性、肿瘤性、感染性疾病密切相关,积极治疗合并症可减少复发.Objective To understand the clinical manifestation of RS3PE syndrome and to reduce an omission and error of diagnosis Methods The symptomes, signs, laboratory characteristic and prognosis of 21 patients with RS3PE syndrome were retrospectively studied and literatures were reviewed Results Twenty one patients with RS3PE were included, with mean age 69 2 years and 19 cases≥ 60 years, involving 18 men and 3 women The main clinical features of the 21 patients were polyarthritis and acute onset of symmetrical edema in both hands and both feet Polyarthritis were involved in proximal interphalangeal and metacarpophalangeal joints in 17 patients(81%) separately, wrists in 12 (57 0%), knees and ankles in 8 (38 0%) respectively, elbows in 4(19 0%) The leucocyte counts increased in 14 patients The average value in erythrocyte sedimentation rate was (90±38) mm/1 h and C reactive protein was (836±122) μg/L Antinuclear antibody was present only in one patient at low titer All patients were in negative values for rheumatoid factor, anti extractable nuclear antigen antibodies, anti dsDNA antibodies and human leukocyte antigen B27 No radiological erosions developed Eight of them suffered from malignant tumors and 7 died of metastasis There coexisted acute pyelonephritis and reactive hemophagocytic syndrome in one case who was cured by antibiotic drugs Polyarthritis and edema were relieved after therapy with low doses of corticosteroids and anti rheumatic drugs But several cases with cancer recurred and were treated by operation and chemical therapy Conclusions RS3PE syndrome is a heterogeneous syndrome. Polyarthritis and edema were relieved after therapy with low doses of corticosteroids and anti rheumatic drugs But it is associated with different rheumatologic, neoplastic, or infectious diseases It will be less recurrent by treating coexisting diseases

关 键 词：对称性滑膜炎 血清阴性 水肿综合征 RS3PE综合征 反应性噬血细胞综合征 人类白细胞相关抗原 抗双链DNA抗体 小剂量泼尼松 凹陷性水肿 外周血白细胞 急性肾盂肾炎 实验室特点 回顾性分析 实验室检查 C反应蛋白 类风湿因子 

分 类 号：R686[医药卫生—骨科学]