评估来自两个不同部门、伴有肌肉骨骼表现的儿童恶性肿瘤:一项多中心研究。

Şengül Çağlayan, Begüm Şirin Koç, Özge Baba, Esra Bağlan, Burçak Kurucu, Deniz Gezgin Yıldırım, Aylin Canbolat Ayhan, Mustafa Çakan, Gülçin Otar Yener, Kübra Öztürk, Figen Çakmak, Hafize Emine Sönmez, Nuray Aktay Ayaz, Ayşenur Paç Kısaarslan, Sevcan Bakkaloğlu, Mukaddes Kalyoncu, Suar Çakı Kılıç, Betül Sözeri
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引用次数: 0

摘要

研究背景本研究旨在评估儿科风湿病学家和儿科血液病学家对具有类似肌肉骨骼(MSK)主诉的患者的治疗方法,并强调普通儿科医生在将患者转诊至这些专科时应考虑的差异:这是一项横断面研究,研究对象包括向儿科风湿病中心提出申请并被确诊为恶性肿瘤的MSK主诉患者,以及在儿科血液病中心接受随访并被确诊为恶性肿瘤的患者,他们在入院时都有MSK主诉:共有 142 名患者参与了研究。在这些患者中,83人(58.4%)向儿科风湿病中心提出申请,59人(41.6%)向儿科血液病中心提出申请。急性淋巴细胞白血病(ALL)是向这两个中心申请的患者中最常见的诊断,共有 80 例(56.3%)。诊断年龄的中位数为87个月(四分位间距:48-140)。儿科风湿病中心最常见的初步诊断是幼年特发性关节炎(JIA),共有 37 例(44.5%)。MSK 受累主要表现为关节痛和骨痛。关节痛(92.7%)是风湿病中心最常见的主诉,而骨痛(88.1%)在血液病中心更为常见。最常受累的关节是膝关节(62.9%)、踝关节(25.9%)、髋关节(25%)和腕关节(14%)。最常见的实验室异常是乳酸脱氢酶(LDH)高、C反应蛋白(CRP)高、贫血和红细胞沉降率(ESR)高。从统计学角度看,血液病中心收治的患者中血小板减少、中性粒细胞减少和乳酸脱氢酶偏高的情况明显多于风湿病中心收治的患者(分别为 p < 0.001、p=0.014、p=0.028)。在风湿病诊所就诊的患者CRP水平明显更高(P=0.032):结论:恶性肿瘤在儿童期可能仅表现为多发性硬化症。因此,恶性肿瘤应被纳入出现 MSK 主诉的患者的鉴别诊断中。
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Evaluation of childhood malignancies presenting with musculoskeletal manifestations from two different divisions: a multicenter study.

Background: The aim of the study was to evaluate the approaches of pediatric rheumatologists and pediatric hematologists to patients with similar musculoskeletal (MSK) complaints and to highlight the differences that general pediatricians should consider when referring patients to these specialties.

Methods: This is a cross-sectional study involving the patients who applied to pediatric rheumatology centers with MSK complaints and were diagnosed with malignancy, as well as patients who were followed up in pediatric hematology centers with a malignancy diagnosis, and had MSK complaints at the time of admission.

Results: A total of 142 patients were enrolled in the study. Of these patients, 83 (58.4%) applied to pediatric rheumatology centers, and 59 (41.6%) applied to pediatric hematology centers. Acute lymphoblastic leukemia (ALL) was the most common diagnosis among the patients who applied to both centers, with 80 cases (56.3%). The median age of diagnosis was 87 (interquartile range, IQR: 48-140) months. The most common preliminary diagnosis in pediatric rheumatology centers was juvenile idiopathic arthritis (JIA), with 37 cases (44.5%). MSK involvement was mainly seen as arthralgia, and bone pain. While arthralgia (92.7%) was the most common complaint in rheumatology centers, bone pain (88.1%) was more common in hematology centers. The most frequently involved joints were the knee (62.9%), ankle (25.9%), hip (25%), and wrist (14%). The most common laboratory abnormalities were high lactate dehydrogenase (LDH), high C-reactive protein (CRP), anemia, and high erythrocyte sedimentation rate (ESR). Thrombocytopenia, neutropenia, and high LDH were statistically significantly more frequent in patients admitted to hematology centers than in patients admitted to rheumatology centers (p < 0.001, p=0.014, p=0.028, respectively). Patients who applied to rheumatology clinics were found to have statistically significantly higher CRP levels (p=0.032).

Conclusions: Malignancies may present with only MSK system complaints in childhood. Therefore, malignancies should be included in the differential diagnosis of patients presenting with MSK complaints.

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