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肿瘤性和副肿瘤性血管炎、血管病变和高凝状态。

Neoplastic and paraneoplastic vasculitis, vasculopathy, and hypercoagulability.

机构信息

Division of Rheumatology, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.

出版信息

Rheum Dis Clin North Am. 2011 Nov;37(4):593-606. doi: 10.1016/j.rdc.2011.09.002.

Abstract

It is essential to be aware of both neoplastic and paraneoplastic vasculitides, vasculopathy, and hypercoagulability, considering the importance of an accurate diagnosis and timely treatment of the underlying malignancy. Characteristics such as the type of vasculitis, age, gender, atypical presentation, and lack of response to common therapies should prompt investigation for an occult malignancy, whereas vasculitis such as GPA require due malignancy vigilance given a significantly increased risk of malignancy at the time of diagnosis and in the following years. Vasculopathies are rarer than vasculitides, but are associated with specific malignancies and, in the context of such malignancies, should be kept in mind. Hypercoagulability is a well-documented neoplastic phenomenon with an increased risk of thrombosis in the setting of positive aPLs. Most neoplastic and paraneoplastic vascular syndromes require no specific treatment outside of treatment of the underlying malignancy. The two key exceptions are PACNS, because of its poor prognosis, and erythromelalgia, in which aspirin is an effective agent.

摘要

需要了解肿瘤性和副肿瘤性血管炎、血管病和高凝状态,因为准确诊断和及时治疗潜在恶性肿瘤非常重要。应根据血管炎的类型、年龄、性别、非典型表现和对常见治疗方法的无反应等特征,提示进行隐匿性恶性肿瘤的检查,而 GPA 等血管炎由于诊断时和随后几年的恶性肿瘤风险显著增加,因此需要适当的恶性肿瘤警惕。血管病比血管炎少见,但与特定的恶性肿瘤相关,在这种情况下,应该牢记在心。高凝状态是一种有充分文献记载的肿瘤现象,在存在阳性抗磷脂抗体的情况下,血栓形成的风险增加。大多数肿瘤性和副肿瘤性血管综合征除了治疗潜在恶性肿瘤外,不需要特殊治疗。只有两种情况是例外,即 PACNS,因为其预后较差,以及红肢痛,阿司匹林在其中是一种有效的药物。

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