【摘要】 目的 分析以皮肌炎副癌综合征为首发表现的原发性肺癌患者发病原因、临床特点，并通过病例分析总结以皮肌炎副癌综合征为首发表现的原发性肺癌患者误诊原因及防范措施。方法 回顾分析2022年5月至2023年10月以皮肌炎副癌综合征为首发表现的原发性肺癌4例误诊病例资料。结果 4例患者均出现四肢近端肌无力、特征性皮疹而误诊，被误诊为过敏性皮炎2例、脂溢性皮炎及湿疹各1例。4例给予对应治疗后病情并未好转，行胸部CT检查提示肺部占位性病变，进一步行肺组织穿刺病理学检查后确诊为皮肌炎合并原发性肺癌。误诊时间1～2个月。确诊后4例均行化疗，治疗后均病情好转出院，随访1年3例死亡、1例病情尚稳定。结论 皮肌炎副癌综合征须引起临床医生的警惕，在诊疗过程中要全面分析患者临床特点，当出现四肢近端肌无力及皮肌炎典型皮疹、吞咽困难症状，胸部CT检查提示肺部占位性病变，肿瘤标志物升高时，须考虑皮肌炎合并原发性肺癌的可能，尽早行肺组织穿刺活检以及早明确诊断。更多还原

【Abstract】 Objective To analyze the causes and clinical characteristics of primary lung cancer patients with paraneoplastic syndrome in dermatomyositis as the initial manifestation, and to summarize the causes of misdiagnosis and preventive measures through case analysis of primary lung cancer patients with paraneoplastic syndrome in dermatomyositis. Methods From May 2022 to October 2023, 4 cases of misdiagnosed primary lung cancer with paraneoplastic syndrome in dermatomyositis as the initial manifestation were retrospectively analyzed. Results Four patients were misdiagnosed as allergic dermatitis(n=2), seborrheic dermatitis(n=1) and eczema(n=1) due to proximal limb muscle weakness and characteristic rash. The condition of 4 patients was not improved after corresponding treatment, and chest CT examination showed lung space occupying lesions, and further lung tissue puncture and pathological examination was performed to confirm dermatomyositis complicated with primary lung cancer. The misdiagnosis lasted 1-2 months. After the diagnosis, all the 4 patients received chemotherapy, and their conditions were improved and discharged. After 1 year of follow-up, 3 patients died and 1 patient was still in stable condition. Conclusion Paraneoplastic syndrome in dermatomyositis should be considered by clinicians, and the clinical characteristics of patients should be comprehensively analyzed during diagnosis and treatment. When there is proximal muscle weakness, dermatomyositis typical rash, dysphagia, chest CT scan showing lung space occupying lesions and elevated tumor markers, the possibility of dermatomyositis combined with primary lung cancer should be considered. Lung biopsy should be performed as early as possible for early diagnosis.更多还原