类风湿关节炎合并脂膜炎1例文献回顾

A Case Review of Rheumatoid Arthritis Com-plicated with Lipomyelitis

摘要: 目的：结合文献重点介绍脂膜炎的临床、病理特点，加深临床医生对脂膜炎的认识和了解，并且让临床医生充分认识到类风湿关节炎(RA)合并脂膜炎的可能性，在类风湿关节炎(RA)患者出现皮下结节时考虑到脂膜炎的可能。方法：收集1例类风湿关节炎(RA)合并脂膜炎的病例，进行临床、病理、鉴别诊断的分析，总结经验。结果：患者，女，59岁，有10年RA病史，3月前无明显原因及诱因出现皮下结节，病理结果示：纤维脂肪组织内查见淋巴细胞浸润，局灶脂肪坏死，符合脂膜炎病理改变，目前诊断“类风湿关节炎(RA)合并脂膜炎”。结论：目前脂膜炎的治疗尚没有明确指南，急性期以大剂量糖皮质激素治疗，也可加用非甾体类抗炎药和免疫抑制剂。当RA患者出现皮下结节时，要考虑到脂膜炎的可能，但也要与类风湿结节、皮下脂膜样T淋巴细胞瘤鉴别，最重要的鉴别手段是病理组织检查。

Abstract: Objective: To introduce the clinical and pathological characteristics of lipitis, deepen the under-standing and understanding of clinicians, and let clinicians fully realize the possibility of rheuma-toid arthritis with lipitis, and consider the possibility of lipitis in RA patients with subcutaneous nodules. Methods: One case of rheumatoid arthritis complicated with lipomyelitis was collected, and the clinical, pathological and differential diagnosis was analyzed, and experience was summarized. Results: The patient, female, 59 years old, had a history of RA for 10 years, and subcutaneous nod-ules appeared 3 months ago without obvious causes or inductions. The pathological results showed that lymphocyte infiltration and focal fat necrosis were observed in the fibrous adipose tissue, which was consistent with the pathological changes of lipomyelitis. At present, the diagnosis was “rheumatoid arthritis complicated with lipomyelitis”. Conclusion: At present, there is no clear guideline for the treatment of lipomyelitis. In acute stage, high-dose glucocorticoid therapy, non-steroidal anti-inflammatory drugs and immunosuppressants can also be used. When subcuta-neous nodules occur in RA patients, the possibility of lipomyelitis should be considered, but it should also be differentiated from rheumatoid nodules and subcutaneous lipomyeloid T-lymphocytoma. The most important means of differentiation is histopathological examination.