肺癌相关神经系统副肿瘤综合征患者临床特点、诊断和预后分析  

Analysis of clinical characteristics,diagnosis and prognosis of patients with lung cancer-related parane-oplastic neurological syndrome

作　　者：邢效如 孙志[1] 郝雅男 赵新春 Xing Xiaoru;Sun Zhi;Hao Yanan;Zhao Xinchun(Department of Neurology,No.983 Hospital of Joint Logistic Support Force of PLA,Tianjin 300142,China)

机构地区：[1]中国人民解放军联勤保障部队第983医院神经内科,天津300142

出　　处：《中国医学前沿杂志（电子版）》2020年第5期109-113,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的分析肺癌相关神经系统副肿瘤综合征(parane-oplastic neurological syndrome,PNS)患者的临床特点、诊断和预后情况。方法回顾性分析中国人民解放军联勤保障部队第983医院2014年1月至2019年1月收治的73例肺癌相关PNS患者的临床资料,总结其临床特点、诊断和预后情况,分析肺癌相关PNS患者临床特点与预后的关系。结果73例肺癌相关PNS患者中,小细胞肺癌(80.82%)和神经系统症状出现于肿瘤确诊前(90.41%)的患者占比较高;11例(15.07%)多部位受累,包括6例(8.22%)多神经部位受累患者和5例(6.85%)合并副肿瘤内分泌综合征患者;52例(71.23%)接受副肿瘤相关抗体检测,30例(57.69%)抗Hu抗体阳性,并有3例同时存在抗γ-氨基丁酸抗体阳性;10例(13.70%)接受肿瘤切除术,63例(86.30%)接受化疗,随访1年发现48例(65.75%)预后良好,25例(34.25%)预后不良(死亡)。11例(15.07%)患者针对PNS治疗,其中,6例(8.22%)患者给予静脉注射免疫球蛋白(intravenous immunoglobulin,IVIG),3例(4.11%)患者接受激素治疗,2例(2.74%)患者接受IVIG联合激素治疗,随访1年发现患者预后均良好。预后不良组中年龄≥60岁、临床分期Ⅲ~Ⅳ期、多部位受累患者占比均显著高于预后良好组(均P<0.05)。结论肺癌相关PNS主要发生于小细胞肺癌患者,大部分患者出现神经系统症状早于肿瘤确诊,早期识别更利于肺癌的诊治,手术切除和免疫治疗可能具有减轻肺癌相关PNS患者神经系统症状的效果,患者年龄、肿瘤临床分期和多部位受累情况与预后密切相关。Objective To analyze the clinical characteristics,diagnosis and prognosis of patients with lung cancer-related paraneoplastic neurological syndrome(PNS).Method The clinical data of 73 patients with lung cancer-related PNS treated in No.983 Hospital of Joint Logistic Support Force of PLA from January 2014 to January 2019 were analyzed retrospectively,and their clinical characteristics,diagnosis and prognosis were summarized.The relationship between clinical characteristics and the prognosis were analyzed.Result Among 73 patients with lung cancer-related PNS,the proportion of patients with small cell lung cancer(80.82%)and neurological symptoms occurring before the diagnosis of the tumor(90.41%)were relatively higher.There were 11 cases(15.07%)with multi-site involvement,included 6 cases(8.22%)with multiple nerve parts involvement and 5 cases(6.85%)with paraneoplastic endocrine syndromes;52 cases(71.23%)were tested for paraneoplastic associated antibodies,showed positive anti-Hu antibodies in 30 cases(57.69%)and positive anti-γ-aminobutyric acid(anti-GABA)antibodies in 3 cases;10 cases(13.70%)underwent tumor resection and 63 cases(86.30%)underwent chemotherapy.After 1 year of follow-up,48(65.75%)patients had good prognosis and 25(34.275%)patients had poor prognosis(death).11(15.07%)patients were treated for PNS,of which 6(8.22%)patients were given intravenous immunoglobulin(IVIG),3(4.11%)patients received hormone therapy,and 2(2.74%)patients received IVIG combined with hormone therapy,those patient's prognosis were good after 1 year of follow-up.The proportion of patients≥60 years old,clinical staging Ⅲ~Ⅳ,and multiple sites involved of poor prognosis group were significantly higher than those of good prognosis group(all P<0.05).Conclusion Lung cancer-related PNS mainly occurs in patients with small cell lung cancer.Most patients have neurological symptoms earlier than the diagnosis of the tumor.Early identification is more conducive to the diagnosis and treatment of lung cancer.Surgical resection and immunot

关 键 词：肺癌 神经系统副肿瘤综合征 临床特点 诊断 预后 

分 类 号：R734.2[医药卫生—肿瘤]