类风湿关节炎并发淋巴瘤的临床特征  

Clinical Characteristics of Lymphoma Associated with Rheumatoid Arthritis

作　　者：刘娣[1,2] 郭万珍 蔡华聪[4] 费允云[1] 张文[1] 张奉春[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院风湿免疫科风湿免疫病学教育部重点实验室,北京100730 [2]长春中医药大学附属医院风湿科,长春130021 [3]内蒙古呼和浩特市和林格尔县人民医院内科,呼和浩特011500 [4]中国医学科学院北京协和医学院北京协和医院血液科,北京100730

出　　处：《中华临床免疫和变态反应杂志》2015年第4期292-296,共5页Chinese Journal of Allergy & Clinical Immunology

基　　金：国家自然科学基金(81202360;81471614)

摘　　要：目的探讨类风湿关节炎（rheumatoid arthritis,RA）并发恶性淋巴瘤（malignant lymphoma,ML）患者的临床特点。方法回顾性分析2005年1月至2014年11月北京协和医院收治的RA并发ML患者的临床资料。结果 RA并发ML患者共11例,占同期RA住院病例的0.53%（11/2093）,其中女性7例,男性4例;RA平均确诊年龄（48.18±12.66）岁（25-67岁）;ML平均确诊年龄（65.55±8.07）岁（49-75岁）;RA确诊到诊断ML病程平均（17.36±10.03）年（2-40年）。所有淋巴瘤病理类型为非霍奇金淋巴瘤;且淋巴结结外受累多见,共6例,占54.5%（6/11）。ML可以侵犯到全身组织和器官,其中胃肠道受累1例,骨髓受累1例,皮下组织受累2例,黏膜组织受累3例。11例RA合并ML的患者中10例炎性指标明显升高（C反应蛋白/红细胞沉降率）。结论 RA并发ML比普通人群风险高,当长病程RA患者出现不明原因发热、组织肿物、淋巴结肿大,需警惕RA并发ML的可能,当RA并发ML多数对化疗敏感。Objective To investigate the clinical characteristics of malignant lymphoma（ ML） associated with rheumatoid arthritis（ RA）. Method Medical data of inpatients at Peking Union Medical College Hospital between January 2005 and November 2014 were reviewed retrospectively to identify patients who were diagnosed as RA associated with ML. Results There were 11 patients（ 4 males and 7 females） who were diagnosed as RA associated ML,accounted for 0. 53%（ 11 /2093） of the inpatients with RA during the same period. When RA was diagnosed,the average age was（ 48. 18 ± 12. 66） years old（ range 25-67 years old）,and（ 65. 55 ± 8. 07） years old（ range 49-75 years old） when ML was diagnosed. The interval between diagnosis of RA and that of ML was（ 17. 36 ± 10. 03） years（ range 2-40 years old）. NonHodgkin＇s lymphoma（ NHL） was the only pathological subtype of these 11 patients（ 100%,11 /11）.Extranodal lymphoma was the most common presentation which was found in 6 patients（ 54. 5%,6 /11）.All tissues and organs of the body could be involved by lymphoma. Involvement of gastrointestinal tract,bone marrow was found in 1 patient. Involvement of subcutaneous tissue were found in 2 patient.Involvement of mucosal tissues were found in 3 patients. Ten out of the 11 patients showed markedly elevated inflammatory indices including C-reactive protein（ CRP） or erythrocyte sedimentation rate（ ESR）.Conclusion RA patients are at high risk of ML than the general population. When the long-lasting RA patients who have fever,mass involved in swollen lymph nodes,one should consider RA associated with lymphoma as one diagnostive possibility. Chemotherapy is sensitive for most RA patients associated with ML.

关 键 词：类风湿关节炎 淋巴瘤 

分 类 号：R593.22[医药卫生—内科学] R733.1[医药卫生—临床医学]