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摘要:
目的 探讨肾脏恶性肿瘤伴发副肿瘤综合征的临床特点及其与预后的关系。 方法 回顾性分析北京协和医院2008年1月至2009年12月464例经手术和病理确诊的肾细胞癌患者的临床资料及其随访结果。 结果 464例肾细胞癌患者中伴发副肿瘤综合征156例(33.6%), 主要临床表现为贫血(26.3%, 41/156)、高血压(24.4%, 38/156)、发热(21.8%, 34/156)、红细胞增多症(19.2%, 30/156)、Stauffer综合征(17.3%, 27/156)、食欲不振、乏力、体重减轻(15.4%, 24/156)、血沉加快(12.8%, 20/156)、白细胞增多症(8.3%, 13/156)、高钙血症(5.1%, 8/156)、糖代谢紊乱(1.9%, 3/156)、性激素异常(0.6%, 1/156)等。156例伴发副肿瘤综合征患者的肿瘤平均直径为5.5 cm, 其余患者肿瘤平均直径为4.7 cm, 两者比较差异有统计学意义(P < 0.01)。 结论 肾脏恶性肿瘤副肿瘤综合征的发生率约为33.6%, 其出现与肿瘤分期有相关性。 Abstract:Objective To investigate the clinical features and prognosis of paraneoplastic syndromes (PNS) in patients with renal carcinoma. Methods The clinical data and follow-up results of 464 patients with surgically and pathologically confirmed renal cell carcinoma (RCC) were retrospectively reviewed. Results Of these RCC cases, PNS was identified in 156 patients (33.6%) and manifested as anemia (26.3%, 41/156), hypertension (24.4%, 38/156), fever (21.8%, 34/156), polycythemia (19.2%, 30/156), Stauffer's syndrome (17.3%, 27/156), fatigue, weight loss, and anorexia (15.4%, 24/156), high erythrocyte sedimentation rate (12.8%, 20/156), leukocytosis (8.3%, 13/156), hypercalcemia (5.1%, 8/156). The average diameter of tumors was 5.5 cm in these 156 patients and was 4.7 cm in the remaining patients (P < 0.01). Conclusion The incidence of RCC is about 33.6% in patients with renal carcinoma, and the morbidity may be associated with the tumor stages. -
Key words:
- paraneoplastic syndrome /
- renal cell carcinoma /
- prognosis
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表 1 肾细胞癌伴发副肿瘤综合征患者临床表现及其结局
临床表现 病例
[n (%) ]性别
(男/女)平均年龄
(岁)肿瘤分期 临床指标 术前 术后 贫血 41 (26. 3) 32: 9 65. 5 T2a-T4N0-N2M0-M1 血红蛋白男平均103 g /L，女
平均97 g /L32例1个月正常，9例较
术前提高3 g /L高血压 38 (24. 4) 27:11 59. 2 T1a-T4N0-N1M0 血压平均165 /90 mm Hg 23例3个月正常，余6
个月收缩压下降20 mm Hg发热 34 (21. 8) 28: 6 51. 7 T1a-T3N0M0-M1 体温平均38. 5℃ 正常 红细胞增多症 30 (19. 2) 25: 5 53. 0 T1b-T4N0-N1M0-M1 血红蛋白167 g /L 25例1周内正常，5例6
个月正常Stauffer综合征 27 (17. 3) 23: 4 61. 8 T1a-T4N0-N2M0-M1 14例ALT升高，4例AST升高，
7例GT升高，3例AKP升高，5
例胆红素升高，11例Alb升高23例正常，4例6个月正
常食欲不振、乏力、体重减轻 24 (15. 4) 18: 6 58. 5 T3a-T4N0-N2M0-M1 体重平均3个月下降3 ~ 4 kg 改善明显，5例6个月内
发生转移血沉加快 20 (12. 8) 14: 6 63. 0 T1a-T4N0M0-M1 血沉44. 9 mm /min 正常 白细胞增多症 13 (8. 3) 9: 4 57. 7 T1a-T4N0-N1M0-M1 白细胞15. 22 × 109 /L 1个月正常 高钙血症 8 (5. 1) 6: 2 45. 2 T2b-T4N0-N1M0-M1 血钙3. 25 mmol /L 6例正常; 2例改变不明
显，6个月内发生肺转移糖代谢紊乱 3 (1. 9) 男 61. 0 T1a-T 3bN0M0 血糖8. 7 mmol /L 正常 性激素异常 1 (0. 6) 男 44. 0 T1aN0M0 雌二醇升高，睾酮降低 正常 ALT:丙氨酸转氨酶; AST:天门冬氨酸氨基转移酶; GT: γ-谷氨酰转移酶; AKP:碱性磷酸酶; Alb:白蛋白 
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