| 陈晓琳,李玲玲,薛 佳,曹 娟,孙 婧,黄 靓,陆邦超,丁从珠.缓解性血清阴性对称性滑膜炎伴凹陷性水肿22例临床回顾[J].,2019,19(10):1898-1902 |
| 缓解性血清阴性对称性滑膜炎伴凹陷性水肿22例临床回顾 |
| Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome: A Retrospective Analysis of 22 Cases |
| 投稿时间：2018-10-10 修订日期：2018-10-30 |
| DOI：10.13241/j.cnki.pmb.2019.10.019 |
| 中文关键词: 滑膜炎 关节炎 缓解性血清阴性对称性滑膜炎伴凹陷性水肿 回顾性研究 |
| 英文关键词: Synovitis Arthritis Remitting seronegative symmetrical synovitis with pitting edema Retrospective study |
| 基金项目:江苏省卫生厅指导性科研项目（201412）；南京市医学科技发展项目（YKK15066） |
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| 中文摘要: |
| 摘要 目的：总结缓解性血清阴性对称性滑膜炎伴凹陷性水肿(RS3PE)的临床特点及转归，为该病的诊治提供更多的参考依据。方法：回顾性分析我院2004年1月至2016年2月的22例我院收治的RS3PE住院病例的临床数据和随访资料，总结该病的特点。结果：本研究纳入男性13例(59.1 %)，女性9例(40.9 %)，平均发病年龄(65.6 ±10.0)岁(40.0 ~ 79.0岁)，发病至确诊时间12天至2年，均为急性起病，并伴有不同程度的对称性多关节炎及肢端水肿。发热6例(27.3 %)。主要实验室指标：血红蛋白(109.1 ± 16.0)g?L-1，血小板计数(277.0 ± 91.8)× 109?L-1，血清白蛋白(36.1 ± 5.0)g?L-1，C反应蛋白(62.5 ± 67.4)mg?L-1，血沉(58.1 ± 33.9)mm/h。测血清铁蛋白的6例中有5例(83.3%)升高，测肿瘤标记的10例均正常。18例(81.8 %)行关节影像学检查，均未见骨破坏。5例行唇腺粘膜活检、2例行骨髓穿刺活检均无异常。住院期间治疗后症状均明显好转，4例(18.2 %)单用糖皮质激素，18例(81.8 %)在激素基础上联用慢作用药物。电话随访4.0月~ 8.0年(中位随访时间5.0年)，有5例(22.7 %)关节症状和肢端水肿持续缓解，4例(18.2 %)症状减轻，1例(4.5 %)反复，3例(13.6 %)发展为类风湿关节炎，9例(40.9 %)失访，确诊淋巴瘤1例(4.5 %)。老年组RS3PE患者红细胞计数、血红蛋白、血清总蛋白及白蛋白低于非老年组。结论：RS3PE多为老年患者，急性起病，为对称性多关节炎伴肢端水肿，常伴贫血及低蛋白血症，对糖皮质激素敏感，有时可伴肿瘤，关于RS3PE的随访观察病例数迄今仍不足。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the clinical characteristics and outcomes of the remitting seronegative symmetrical synovitis with pitting edema (RS3PE), and help the diagnosis and treatment. Methods: A retrospective review of RS3PE patients diagnosed from January 1, 2004 to February 29, 2016 was performed. The clinical data and follow-up information were collected. The characteristics of RS3PE were summarized by description, comparison of the means, ratios or medians. Results: We identified 13 males (59.1 %) and nine females (40.9 %) RS3PE cases. The mean onset age was 65.6 ±10.0 years (40.0 to 79.0 years). Diagnosis time to onset was 12 days to two years. All patients were acute onset with varying degrees of symmetric polyarthritis and extremity edema. Six cases (27.3 %) presented fever. The means of main laboratory indicators were as following: hemoglobin 109.1 ±16.0 g?L-1, platelet count 277.0 ±91.8 × 109?L-1, serum albumin 36.1 ±5.0 g?L-1, c-reactive protein 62.5 ±67.4 mg?L-1, erythrocyte sedimentation rate 58.1 ±33.9 mm/h. Serum ferritins tested in six cases were elevated in five (83 %). Tumor markers detected in ten cases were all normal. Eighteen cases (86 %) underwent joint iconographic examination, and no bone destruction was found. Both five cases performed labial gland mucosal biopsy and two cases received bone marrow biopsy were normal. Symptoms were significantly improved in all cases during hospitalization. Four cases were prescribed with glucocorticoids alone, and 18 (81.8 %) also combined with slow-acting drugs. During the telephone follow- up period of four months to eight years (the median was 5.0 years), the joint symptoms and extremity edema continued to ease in five cases (22.7 %), and relieved in four cases (18.2 %). Only one (4.5 %) was recurrent, and three (13.6 %) developed rheumatoid arthritis. Nine cases (40.9 %) were lost. Malignant tumor happened in one case (4.5 %). The erythrocyte count, hemoglobin, serum total protein and albumin in the elderly RS3PE patients were lower than those in the non-elderly group. Conclusion: RS3PE is mostly acute onset in elderly patients, accompanied by symmetrically multiple arthritis with acroedema. In addition to be sensitive to glucocorticoid therapy, RS3PE often presents as anemia and hypoproteinemia, and sometimes accompanied by tumor. The study of RS3PE is still insufficient so far. |
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