Whelan T V, Hirszel P
Department of Medicine, Naval Hospital, Bethesda, Md.
Arch Intern Med. 1988 Apr;148(4):975-6.
A 67-year-old man presented with nephrotic syndrome and polymyalgia rheumatica. A renal biopsy revealed minimal-change nephropathy. The proteinuria and rheumatologic findings responded to prednisone therapy. The patient presented three months later with biliary tract obstruction secondary to pancreatic adenocarcinoma metastatic to the liver. The glomerulopathy and polymyalgia rheumatica in this case seemed to be components of the paraneoplastic syndrome. The response of both entities to prednisone therapy supports the hypothesis that they are caused by derangements in cell-mediated immunity. The fact that the tumor progressed despite resolution of the nephrosis and polymyalgia rheumatica suggests that cell-mediated immunity in general is altered by the tumor and not that the carcinoma liberates a factor that directly damages the kidney.
一名67岁男性患者出现肾病综合征和风湿性多肌痛。肾活检显示为微小病变性肾病。蛋白尿和风湿学表现对泼尼松治疗有反应。三个月后，该患者因胰腺腺癌转移至肝脏继发胆道梗阻。本例中的肾小球病和风湿性多肌痛似乎是副肿瘤综合征的组成部分。这两种病症对泼尼松治疗的反应支持了它们是由细胞介导免疫紊乱引起的假说。尽管肾病和风湿性多肌痛得到缓解，但肿瘤仍进展，这一事实表明一般情况下细胞介导免疫被肿瘤改变，而非癌释放直接损害肾脏的因子。
