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继发性肥大性肺骨关节病治疗方法的综述。

Review of current therapies for secondary hypertrophic pulmonary osteoarthropathy.

机构信息

University of Minnesota Medical School, Minneapolis, MN, USA.

出版信息

Clin Rheumatol. 2011 Jan;30(1):7-13. doi: 10.1007/s10067-010-1563-7. Epub 2010 Oct 9.

Abstract

Hypertrophic osteoarthropathy (HOA) is a disabling condition that may occur secondarily to primary lung cancer. It is characterized by digital clubbing, arthralgia/arthritis, and periostosis of the tubular bones. The pain associated with HOA can be disabling and often refractory to conventional analgesics. We performed a comprehensive review of the literature using the PubMed database on treatment modalities available for HOA. We found 52 relevant articles-40 case reports, six case series, two review papers, and four combined case series and review papers. There were no randomized controlled trials reported. We then classified treatments used for HOA into two categories: (1) treatment of primary cause (i.e., resection of tumor, chemotherapy, radiotherapy, treatment of infection, etc.) and (2) symptomatic treatments (i.e., bisphosphonates, octreotide, NSAIDs, vagotomy, etc.). Subsequently, we summarized the main findings for each treatment. Although the clinical diagnosis of HOA has existed for over 100 years, the pathogenesis mechanism has not yet been elucidated, and treatment options for this condition remain experimental. Primary treatment is the most widely reported modality to be efficacious. In cases which primary therapy is not possible, several symptomatic treatment modalities are suggested, with various degree of success. Further research is needed to clarify the pathophysiological mechanism of HOA as to appropriately direct therapy.

摘要

肥大性骨关节病(HOA)是一种致残性疾病,可能继发于原发性肺癌。其特征为指(趾)末端呈杵状膨大、关节痛/关节炎和管状骨骨膜增生。HOA 相关疼痛可能导致患者残疾,且通常对常规镇痛药有抗性。我们使用 PubMed 数据库对肥大性骨关节病的治疗方法进行了全面的文献回顾。我们发现了 52 篇相关文章,包括 40 篇病例报告、6 篇病例系列研究、2 篇综述文章和 4 篇病例系列研究和综述文章。没有报告随机对照试验。然后,我们将用于治疗 HOA 的治疗方法分为两类:(1)治疗原发性病因(即肿瘤切除术、化疗、放疗、感染治疗等)和(2)对症治疗(即双膦酸盐、奥曲肽、非甾体抗炎药、迷走神经切断术等)。随后,我们总结了每种治疗方法的主要发现。尽管 HOA 的临床诊断已经存在了 100 多年,但发病机制尚未阐明,这种疾病的治疗选择仍然是实验性的。主要治疗是最广泛报道的有效治疗方法。在无法进行主要治疗的情况下,建议使用几种对症治疗方法,但成功率各不相同。需要进一步研究以阐明 HOA 的病理生理机制,从而为治疗提供适当的指导。

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