1型抗神经核自身抗体血清阳性患者的副肿瘤和肿瘤特征

摘要

1型抗神经元核自身抗体(ANNA-1，也称为“抗- hu”)是一种神经自身免疫标志物，与小细胞肺癌(SCLC)高度相关。为了确定ANNA-1血清阳性的成年患者的症状和体征谱以及癌症的频率，我们回顾了在综合免疫荧光筛查试验中被确定为ANNA-1阳性的162例序贯患者(67%女性)。在21%的患者中，医生要求的抗体测试不是ANNA-1。到随访期结束时，142例患者(88%)发现癌症。其中10例缺乏SCLC的证据(4例为前列腺癌，3例为乳腺癌，1例为前列腺癌和黑色素瘤，1例为淋巴瘤，1例为鳞状细胞肺癌)。在132例(81%)确诊的SCLC患者中，17例同时存在一种或多种恶性肿瘤(6例为肾癌，4例为肺原发癌，3例为前列腺癌，3例为乳腺癌，4例为各种肿瘤)。128例患者(97%)在副肿瘤症状出现后被诊断为SCLC。10例患者在胸片或CT不明确后，经胸部MRI确诊为SCLC;28例经支气管镜、纵隔镜或开胸;7号解剖。 Neurologic signs in decreasing frequency were neuropathy (sensory> mixed somatic > autonomic > cranial [especially cranial nerve VIII] > motor), cerebellar ataxia, limbic encephalitis, polyradiculopathy, associated Lambert-Eaton myasthenic syndrome, myopathy, myelopathy, opsoclonus/myoclonus, motor neuronopathy, brachial plexopathy, and aphasia. Nineteen patients had a solely gastrointestinal initial presentation, including gastroparesis, pseudo-obstruction, esophageal achalasia, or other dysmotility. We conclude that seropositivity for ANNA-1 can expedite the diagnosis and treatment of otherwise occult cancer in patients, especially tobacco abusers, with varied neurologic and gastroenterologic presentations. The search for SCLC should not end on discovering a different neoplasm.