肺癌相关副肿瘤性边缘叶脑炎临床分析  

Lung cancer associated paraneoplastic limbic encephalitis： an analysis of 7 cases

作　　者：秦应之[1] 陈野野[1] 邴钟兴[1] 黄诚[1] 李力[1] 梁乃新[1] 刘洪生[1] 李单青[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院胸外科,100730

出　　处：《中华外科杂志》2013年第10期900-903,共4页Chinese Journal of Surgery

摘　　要：目的 分析肺癌相关副肿瘤性边缘叶脑炎（PLE）的临床特征和诊治要点.方法 回顾性总结2000年1月到2010年5月收治的8927例肺癌患者的临床资料,根据2004年神经系统副肿瘤综合征欧洲工作网制定的PLE诊断标准,从中筛选出PLE患者共7例,均为男性,年龄41～ 54岁,平均48岁；分析其诊断、治疗及预后情况.结果 7例患者均有吸烟史.症状方面,7例均有不同程度的短期记忆力丧失,6例有癫痫发作,4例有不同程度的精神异常,2例合并抗利尿激素分泌不当综合征.肿瘤发现均依靠胸部X线片或CT检查.病理确诊主要依靠纤维支气管镜（5例）,2例手术确诊；其中小细胞肺癌6例,肺腺癌1例.1例失访,6例随访4～21个月,平均11.5个月.治疗后神经系统症状完全缓解3例,部分缓解3例.3例死亡（生存期分别为4、10、14个月）,肿瘤分期分别为Ⅳ期、Ⅲb期和Ⅲa期；3例随访中（随访时间分别为5、15、21个月）,均为Ⅲa期,其中1例接受手术治疗及术后辅助化疗.结论 PLE为罕见疾病,熟悉疾病特点有助于早期诊断,抗肿瘤治疗能有效改善神经系统症状,神经系统症状缓解不完全以及肺癌分期偏晚可能与较差的预后相关.Objective To analyze the clinical features,diagnosis and treatment of lung cancer associated paraneoplastic limbic encephalitis （PLE）.Methods The clinical data of 7 cases of patients with lung cancer associated PLE out of 8927 patients of lung cancer from January 2000 to May 2010 was analyzed retrospectively.All the patients were male,aging from 41 to 54 years with a mean of 48 years.The data including history,physical examination,laboratory tests,diagnosis,treatment and follow-up were collected and analyzed.Results All the 7 patients had smoking history.All 7 patients had varying shortterm memory loss,6 had epilepsy,4 had different degrees of mental disorders,and 2 had syndrome of inappropriate secretion of antidiuretic hormone.Malignancies were screened and detected by chest X-ray or CT scan,while the pathological diagnoses were obtained through biopsy or transbronchial needle aspiration through electronic bronchoscope （5/7）,biopsy of supraclavicular lymph nodes （1/7） and open pulmonary lobectomy （1/7）.The pathological diagnosis included small cell lung cancer in 6 cases,adenocarcinoma of lung in 1 case.During the follow-up,1 patient was lost,and the mean time of follow-up of the remaining 6 patients was about 11.5 months （ranged from 4 to 21 months）.Four patients received early immunosuppressive treatment in terms of corticosteroids,only slight relief of neurological symptoms was seen in 2 patients.However,after chemotherapy （6/6）,radiation （3/6）,or surgical removal of the tumor （1/6）,complete remission （3/6,with negative anti-Hu antibody） or partial remission （3/6,2 of whom with positive anti-Hu antibody） of neurological symptoms were observed.Till October 2010,3 patients with poorer tumor stag died （survival were 4,10,and 14 months respectively）,while the other 3 patients with negative anti-Hu antibody and relative better tumor stag were still in the follow-up （the period were 5,15,and 21 months）.Conclusions PLE is a rare disease.In comparison with immunosuppre

关 键 词：边缘叶脑炎 肺肿瘤 癌 小细胞 

分 类 号：R734.2[医药卫生—肿瘤]