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中华临床医师杂志(电子版) ›› 2025, Vol. 19 ›› Issue (08) : 601 -605. doi: 10.3877/cma.j.issn.1674-0785.2025.08.007

综述

恶性肿瘤相关皮肌炎的病理机制与临床管理研究进展
张建锋1, 马洪庆1, 武雪亮2, 郭甘霖1, 孟泽松1, 冯鋆1, 赵泽铭3, 王贵英1,3,()   
  1. 1 050001 石家庄,河北医科大学第四医院外二科
    2 075132 张家口,河北北方学院附属第一医院普外科
    3 050000 石家庄,河北医科大学第二医院普外科
  • 收稿日期:2025-08-04 出版日期:2025-08-30
  • 通信作者: 王贵英
  • 基金资助:
    国家自然科学基金项目(82272909); 河北省自然基金创新研究群体项目(H2022206355); 河北省医学科学研究课题(20260505)

Pathogenesis and clinical management of cancer-associated dermatomyositis

Jianfeng Zhang1, Hongqing Ma1, Xueliang Wu2, Ganlin Guo1, Zesong Meng1, Jun Feng1, Zeming Zhao3, Guiying Wang1,3,()   

  1. 1 Department of Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang 050001, China
    2 Department of General Surgery, First Affiliated Hospital of Hebei North University, Zhangjiakou 075132, China
    3 Department of General Surgery, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
  • Received:2025-08-04 Published:2025-08-30
  • Corresponding author: Guiying Wang
引用本文:

张建锋, 马洪庆, 武雪亮, 郭甘霖, 孟泽松, 冯鋆, 赵泽铭, 王贵英. 恶性肿瘤相关皮肌炎的病理机制与临床管理研究进展[J/OL]. 中华临床医师杂志(电子版), 2025, 19(08): 601-605.

Jianfeng Zhang, Hongqing Ma, Xueliang Wu, Ganlin Guo, Zesong Meng, Jun Feng, Zeming Zhao, Guiying Wang. Pathogenesis and clinical management of cancer-associated dermatomyositis[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(08): 601-605.

恶性肿瘤相关皮肌炎(CADM)是一种与肿瘤高度相关的副肿瘤综合征,其早期识别对恶性肿瘤的诊断和治疗至关重要。本文系统阐述了CADM的病理机制与临床管理的最新进展。在机制层面,重点探讨了肿瘤抗原驱动的自身免疫反应的核心作用,并解析了肿瘤微环境中的炎症因子机制、遗传易感性以及“炎性衰老”的协同机制;在临床管理方面,提出了基于抗体谱与临床特征的风险分层筛查策略,探讨了免疫抑制剂和生物制剂在肿瘤共存状态下的治疗效果与安全性及肿瘤治疗对皮肌炎(DM)症状改善的影响。此外,本文还强调了多学科协作(MDT)模式在疾病管理中的重要性,探讨了其预后影响因素,指出了当前在筛查成本效益、靶向治疗安全性等方面存在的争议,为临床实践提供了循证依据。

Cancer-associated dermatomyositis (CADM) is a paraneoplastic syndrome highly associated with tumors, and its early identification is crucial for the diagnosis and treatment of malignant tumors. This article systematically reviews the latest progress in the pathogenesis and clinical management of CADM. At the mechanistic level, it focuses on the central role of tumor antigen-driven autoimmune responses, along with the synergistic effects of inflammatory factor cascades, genetic susceptibility, and "inflammatory aging" in the tumor microenvironment. From a clinical perspective, a risk-stratified screening strategy based on antibody profiles and clinical characteristics is proposed. The therapeutic efficacy and safety of immunosuppressants and biologics in patients with concurrent tumors are discussed, as well as the impact of anti-tumor treatment on the improvement of dermatomyositis symptoms. Furthermore, this article highlights the significance of the multidisciplinary team model in disease management, examines prognostic influencing factors, identifies current controversies such as the cost-effectiveness of screening and the safety of targeted therapy, and offers an evidence-based foundation to inform clinical practice.

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