以皮肤改变、肌肉痛及关节痛表现起病的心房黏液瘤的病例分析及文献复习  

Case analysis and literature review of atrial myxoma with skin changes,muscle pain and arthralgia

作　　者：马建鹏 孙金梅[1] 朱先进 张拥波[1] 脱厚珍[1] MA Jian-peng;SUN Jin-mei;ZHU Xian-jin(Department of Neurology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院神经内科,北京100050

出　　处：《临床和实验医学杂志》2024年第19期2034-2037,共4页Journal of Clinical and Experimental Medicine

基　　金：吴阶平医学基金(编号:320.6750.2020-06-18)。

摘　　要：目的探讨心房黏液瘤引起皮肤改变、关节、肌肉疼痛的机制。方法搜集2017年1月至2024年1月首都医科大学附属北京友谊医院收治的表现关节痛、肌肉痛、皮肤改变的5例心房黏液瘤患者资料。并通过搜集Pubmed、web science等网站发表的以皮肤改变或关节痛或肌肉疼痛为特征表现的心房黏液瘤患者15例。对以上20例患者在病例及文章中给出的临床症状、化验、病理检查结果进行综合分析。结果20例患者中,男女比例1∶3,诊断年龄6~77岁,平均(43.59±19.97)岁;14例患者表现皮肤改变,5例起病表现为反复的关节疼痛,关节痛或皮肤改变合并肌肉痛6例。仅1例患者皮肤改变合并肌肉疼痛、关节痛。其中11例患者进行了皮肤活检,7例真皮血管内发现黏液瘤组织。9例患者出现明确的大血管栓塞事件包含脑血管、肺动脉、下肢近段大血管等。20例患者均经超声心动图检查明确诊断。其中19例行黏液瘤摘除术治疗,并完善病理检查确诊。1例因高龄拒绝手术,长期口服利伐沙班抗凝治疗。结论心房黏液瘤早期表现为皮肤改变、肌肉疼痛,可能是黏液瘤组织脱落栓塞至微小动脉所致。Objective To investigate the mechanism of skin changes,joint and muscle pain in patients with atrial myxoma.Methods The data of 5 patients with atrial myxoma presenting with joint pain,muscle pain and skin changes admitted to Beijing Friendship Hospital,Capital Medical University from January 2017 to January 2024 were collected.And 15 patients with atrial myxoma characterized by skin changes or joint pain or muscle pain were collected from Pubmed,web science and other websites.The clinical symptoms,laboratory and pathological examination results of the above 20 patients in the cases and articles were comprehensively analyzed.Results Among the 20 patients,the ratio of male to female was 1∶3,and the age of diagnosis was 6-77 years old,mean(43.59±19.97)years old.Fourteen patients showed skin changes,5 patients had recurrent joint pain,and 6 patients had joint pain or skin changes combined with muscle pain.Only 1 patient had skin changes combined with muscle pain and joint pain.Of these,skin biopsies were performed in 11 patients,and myxoma tissues were found in dermal vessels in 7 patients.Nine patients had definite events of great vessel embolization,including cerebrovascular,pulmonary artery,and proximal great vessels of lower limbs.All 20 patients were diagnosed by echocardiography.Among them,19 patients were treated with myxoma excision and confirmed by pathological examination.One patient refused surgery due to old age and received long-term oral anticoagulant therapy with rivaroxaban.Conclusion The early manifestation of atrial myxoma is skin change and muscle pain,which may be caused by the tissue of myxoma to embolize the tiny artery.

关 键 词：非特异 黏液瘤 肌痛 紫癜 红斑 皮肤血管栓塞 微小动脉 

分 类 号：R732.1[医药卫生—肿瘤]