肥厚性骨關節病變：三病例報告

肥厚性骨關節病變是一種徵候群，包括杵狀指（趾）、關節炎及骨膜增生。臨床症狀通常極為顯著，病人常主訴四肢及關節腫痛。此種徵候群主要發生於有肺部病灶患者，尤其是支氣管肺癌及其他癌症合併肺部轉移。致病機轉目前衛未完全明瞭，但種種跡象顯示肺都病灶局部刺激迷走神經，傳入中摳，再由輸出支傳出訊號，引起骨及關節發炎反應。本文即報告三例肥厚性骨關節病變，第一例是食道癌合併肺部轉移，第二例是鼻咽癌也合併肺部轉移，第三例是支氣管肺癌，以供參考。

關鍵字

肥厚性骨關節病變；肺部病灶

並列摘要

Hypertrophic osteoarthropathy (HOA) is a syndrome consisting of clubbing of the fingers and toes, a painful symmetrical arthropathy, and a proliferative periostitis along the long bones. It often associates clinically with intra-pulmonary lesions, especially the bronchogenic carcinoma and metastatic tumors to the lung. The pathophysiologic mechanisms leading to HOA is at present unclear. However, it is supposed that there is a signal generated by the intra-pulmonary lesion and transmitted via vagus nerve to the central nervous system, discharging a stimulus via the efferent vagal pathway to the target tissue/organ making a hypertrophic osteoarthropathy. Three cases of HOA were seen at Tri-Service General Hospital over the past two years. The first patient had a lower third esophageal epidermoid carcinoma surgically removed one month before the onset of HOA; the second had a previously irradiated nasopharyngeal epidermoid carcinoma with recent metastasis to the lung; and the third had a newly diagnosed bronchogenic carcinoma. The symptoms of HOA were well relieved by indomethacin 100 mg/day and 200 mg/day in the first and second cases, respectively, and by Pro-Banthine 15 mg, qid in the third case.

並列關鍵字

Hypertrophic osteoarthropathy ； Symmetrical arthropathy

國際替代計量

肥厚性骨關節病變：三病例報告

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