84例典型副肿瘤抗体阳性者肿瘤诊断率及肿瘤标志物检测状况分析  

Tumor diagnostic rate and tumor marker determination for 84 patients with typical paraneoplastic antibody positive

作　　者：刘霞 吴艳艳[1] 王金玲[1] 兰贺[1] 刘丽[1] 王培昌[1] LIU Xia;WU Yanyan;WANG Jinling;LAN He;LIU Li;WANG Peichang(Department of Clinical Laboratory,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院检验科,北京100053

出　　处：《检验医学》2018年第8期702-706,共5页Laboratory Medicine

摘　　要：目的探讨典型副肿瘤抗体阳性者肿瘤诊断率低下的原因。方法分别用免疫印迹法和电化学发光法检测神经元抗原谱Ig G抗体和肿瘤标志物。通过终末电子病例查询,收集典型副肿瘤抗体(Ig G)阳性者终末诊断、肿瘤标志物检测结果等信息。结果 84例典型副肿瘤抗体阳性者中抗Hu抗体、抗Ri抗体、抗Yo抗体、抗PNMA2(Ma2/Ta)抗体、抗CV2抗体和抗Amphiphysin抗体阳性例数分别为15(17.9%)、0(0.0%)、18(21.4%)、26(31.0%)、9(10.7%)、12(14.3%)例。抗CV2抗体及抗PNMA2(Ma2/Ta)抗体均阳性3例(3.6%),抗CV2抗体及抗Hu抗体均阳性1例(1.2%)。84例典型副肿瘤抗体阳性者的肿瘤诊断率为14.3%,其中抗Amphiphysin抗体阳性、抗Hu抗体阳性者肿瘤诊断率仅为7.4%。72例典型副肿瘤抗体阳性且未诊断为肿瘤的受检者中有14例(19.4%)未进行肿瘤标志物检测,58例行肿瘤标志物检测的受检者中肿瘤标志物结果正常和异常者分别为27例(46.6%)和31例(53.4%)。结论典型副肿瘤抗体阳性者肿瘤漏诊率高,肿瘤标志物漏检、对肿瘤标志物结果正常者进一步探查肿瘤意识不足以及对肿瘤重点探查部位把握不准确等可能是漏诊的主要原因。Objective To investigate the cause for low tumor diagnostic rate for patients with typical paraneoplastic antibody positive.Methods Neuronal antigen IgG antibody was determined by immunoblotting assay. Tumor markers were determined by chemiluminescence. The clinical data,including the results of tumor biomarkers and diagnosis for patients with typical paraneoplastic antibody positive,were collected through terminal electronic medical record.Results There were 15（17.9%）,0（0.0%）,18（21.4%）,26（31.0%）,9（10.7%） and 12（14.3%） positive cases of anti-Hu,anti-Ri,anti-Yo,anti-PNMA2（Ma2/Ta）,anti-CV2 and anti-Amphiphysin antibodies,respectively. There were 3 positive cases of both anti-CV2 and anti-PNMA2（Ma2/Ta） antibodies and 1 positive case of both anti-CV2 and anti-Hu antibodies. Tumors were found in 14.3% patients of 84 cases of typical paraneoplastic antibody positive. Moreover,7.4% patients with positive anti-Hu or anti-Amphiphysin antibodies were diagnosed with tumors. Tumor markers were not determined in 14 of 72 patients（19.4%） who were not diagnosed with tumors. The negative rate and the positive rate of tumor markers were 46.6%（27 cases） and 53.4%（31 cases） in 58 patients who were not diagnosed with tumors,respectively.Conclusions The tumor missed diagnosis rate is high in patients with typical paraneoplastic antibody positive,which could be due to the missed determination of tumor markers,no further determination of tumors in patients with normal tumor marker determination results and inaccurate site of tumor examination.

关 键 词：典型神经元副肿瘤抗体 神经元抗体谱抗体 肿瘤标志物 神经系统副肿瘤综合征 

分 类 号：R446.1[医药卫生—诊断学]