抗SOX1抗体阳性副肿瘤性小脑变性一例  

A case report of anti-SOX1 antibody related paraneoplastic cerebellar degeneration

作　　者：刘静[1] 樊春秋[1] 刘爱华[1] 杨冬菊[1] 陈芳[1] 户宁宁 Liu Jing;Fan Chunqiu;Liu Aihua;Yang Dongju;Chen Fang;Hu Ningning(Department of Neurology,the Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053

出　　处：《脑与神经疾病杂志》2022年第9期558-563,共6页Journal of Brain and Nervous Diseases

摘　　要：目的 探讨抗SOX1抗体阳性副肿瘤性小脑变性的诊疗要素。方法 北京首都医科大学宣武医院神经内科报道1例抗SOX1抗体阳性副肿瘤性小脑变性患者,分析其诊治过程中的关键点和经验。结果 患者中年男性,急性起病,以小脑性共济失调为主要表现,肺部占位伴纵隔淋巴结肿大,PETCT代谢增高,血清副肿瘤抗体谱:抗SOX1抗体(+),左肺占位穿刺活检病理结果提示炎症性病变,发病第4个半月门诊随诊发现胃泌素释放肽前体(645.20pg·mL^(-1))、神经元特异性烯醇化酶(93.47 pg·mL^(-1))升高,超声引导下支气管镜下纵隔淋巴结组织活检,淋巴结活检病理证实为小细胞肺癌,确诊后给与阿替利珠单抗治疗过程中出现药物相关PD-L1相关脑炎,神经系统症状经类固醇联合免疫球蛋白治疗好转。结论抗SOX1抗体阳性与小细胞肺癌关系密切,抗SOX1抗体阳性副肿瘤综合征可以以小脑变性为主要表现。肿瘤患者阿替利珠单抗等PD-L1抑制剂治疗过程中,需注意免疫相关不良反应,少数患者会出现PD-L1相关脑炎。Objective To investigate the diagnosis and treatment factors of anti-SOX1 positive paraneoplastic cerebellar degeneration.Method A case of paraneoplastic cerebellar degeneration with positive anti-SOX1 antibody was reported to analyze the key points and experience in diagnosis and treatment.Results The patient was a middleaged male with acute onset and the main manifestation was cerebellar ataxia.His lung space occupation with mediastinal lymph node enlargement,increased PETCT metabolism,serum paraneoplastic antibody spectrum:antiSOX1 antibody(+).The pathologic findings of the left lung placeholder biopsy suggested inflammatory lesions.At the fourth and a half month after the onset of the disease,the levels of gastrin-releasing peptide precursors(645.20 pg·mL^(-1))and neuron-specific enolase(93.47 pg·mL^(-1)) were found to be elevated.Mediastinal lymph node tissue biopsy under bronchoscopy guided by ultrasound was finally confirmed as small cell lung cancer by lymph node biopsy pathology.PD-L1 associated encephalitis occurred during attilizumab treatment after diagnosis,and the neurological symptoms were improved by steroid combined with immunoglobulin therapy.Conclusion Anti-SOX1 antibody is closely related to small cell lung cancer.Cerebellar degeneration can be the main manifestation of paraneoplastic syndrome with positive anti-SOXl antibody.During the treatment of PD-L1 inhibitors in tumor patients,attention should be paid to immune-related adverse reactions,and PD-L1 related encephalitis may occur in a few patients.

关 键 词：抗SOX1抗体 副肿瘤性小脑变性 PD-L1相关脑炎 小细胞肺癌 

分 类 号：R739.4[医药卫生—肿瘤]