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題 名 | Malignant Thymoma-Associated Refractory Minimal Change Nephropathy: A Case Report and Review of the Literature=惡性胸腺瘤合併頑固性微小腎病變--病例報告及文獻回顧 |
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作 者 | 陳國榮; 鄭志雄; 吳明儒; 陳呈旭; 連榮達; 徐國雄; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷 期 | 16:1 2002.03[民91.03] |
頁 次 | 頁35-38+54 |
分類號 | 415.74 |
關鍵詞 | 腎病症候群; 微小腎病變; 惡性胸腺瘤; Cyclosporine; Cyclophosphamide; Minimal change nephropathy; Nephrotic syndrome; Thymoma; |
語 文 | 英文(English) |
中文摘要 | 腎病症候群的原因很多,在成人中,與癌症有關的腎病症候群,70%為膜性腎病變;微小腎病變則與Hodgkin’s lymphoma有關。本篇報導一個66歲男性病人,在惡性胸腺瘤開刀3年後,無證據顯示有胸腺瘤復發的情況下,出現微小腎病變。對steroid,cyclophosphamide的治療效果不佳;使用cyclosporin A也只能有部份的效果。文獻上計載26個與惡性胸腺瘤有關的腎病症候群,以minimal change nephropathy (MCN)佔最多有13個,membranous GN (MGN) 其次有5個,focal segmental GS (FSGS)有3個,proliferative GN (PGN)有2個,extracapillary GN (EGN) 有1個。而且這續發性的微小腎病變,病因不明,可能與以下有關:paraneoplastic syndrome,T-cell的異常活化,基因的因素,腫瘤內的蛋白質與受到免疫系統攻擊的器官內的蛋白質有某些程度的相似。這類病人,即使無腫瘤復發,對治療的效果仍然不佳。文獻上指出26個病人中,有12個成為慢性腎衰竭,14個病人每天蛋白尿仍然超過一公克,3個病人部份緩解,6個病人完全緩解。是故,本文指出與惡性胸腺瘤有關的腎病症候群以微小腎病變為主,佔54%,而且治療效果不彰;使用steroid、cyclophosphamide無效且副作用大(尤其是累積計量超過20克時),cyclosproin A是另一個值得考慮的選擇。 |
英文摘要 | In 1993, a 66-year-old man presented with persistent dyspnea and productive cough for several months. Radiological examinations revealed a mediastinal mass and lung metastasis, consistent with malignant thymoma. Radical thymectomy and lobectomy of right middle lung were performed and pathological examination showed invasive malignant thymoma. Adjuvant radiotherapy was applied for lung metastasis and there was no residual tumor in the following 3 years. However, full-blown nephritic syndrome developed in 1996. A renal biopsy revealed minimal change nephropathy. The disease was refractory to prednisolone therapy alone, but partially responded to combined therapy of prednisolone and cyclophosphamide. When switched to cyclosporine, no additional benefit was obtained. Serum creatinine remained normal despite persistent heavy proteinuria. The possible linkage between minimal change nephritic syndrome and thymoma is discussed. |
本系統中英文摘要資訊取自各篇刊載內容。