案例
一位 70 岁的男性,表现为几个月内缓慢进展的全身性疲乏。体格检查发现该患者粘膜苍白且伴有轻微心动过速。体查其他部分未见明显异常。
其他表现
许多患者在就诊时无症状,但在常规实验室检查时发现 MDS。如果症状进展,通常无特异性且和贫血有关——例如虚弱、疲乏、运动耐受力降低、头晕或心绞痛。[2]Swerdlow SH, Campo E, Harris NL, et al, ed. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon, France: IARC; 2008.[3]Meyers CA, Albitar M, Estey E. Cognitive impairment, fatigue, and cytokine levels in patients with acute myelogenous leukemia or myelodysplastic syndrome. Cancer. 2005;104:788-793.http://www.ncbi.nlm.nih.gov/pubmed/15973668?tool=bestpractice.com 瘀青、出血和感染等症状较不常见。[4]Pomeroy C, Oken MM, Rydell RE, et al. Infection in the myelodysplastic syndromes. Am J Med. 1991;90:338-344.http://www.ncbi.nlm.nih.gov/pubmed/2003516?tool=bestpractice.comMDS 偶尔也表现为自身免疫异常,如关节炎、心包炎、胸腔积液、皮肤溃疡、葡萄膜炎、肌炎和周围神经病变。罕见情况下,患者可能急性起病,表现为皮肤血管炎、发热、关节炎、外周水肿和肺部浸润。[5]Enright H, Jacobs HS, Vercellotti G, et al. Paraneoplastic autoimmune phenomena in patients with myelodysplastic syndromes: response to immunosuppressive therapy. Br J Haematol. 1995;91:403-408.http://www.ncbi.nlm.nih.gov/pubmed/8547082?tool=bestpractice.com