Graus F, Vega F, Delattre J Y, Bonaventura I, Reñé R, Arbaiza D, Tolosa E
Department of Neurology, Hospital Clinic i Provincial, Barcelona, Spain.
Neurology. 1992 Mar;42(3 Pt 1):536-40. doi: 10.1212/wnl.42.3.536.
We retrospectively evaluated the effect of plasmapheresis (PE) in seven patients with paraneoplastic encephalomyelitis (PEM), small-cell lung carcinoma, and anti-Hu antibodies, and four patients with paraneoplastic cerebellar degeneration (PCD), ovarian or breast cancer, and anti-Yo antibodies. In addition to PE, patients received prednisone (nine), cyclophosphamide (eight), or treatment of the tumor (five). All but one patient were severely disabled by the time PE began. The clinical outcome was compared with that of five patients (PEM, four; PCD, one) who only had treatment of the tumor. Only one of these five patients had a severe neurologic deficit at the onset of the antineoplastic treatment. No patient improved. Two patients treated with PE and antineoplastic therapy and three who only received treatment of the tumor remained stable for at least 6 months. Four of the five patients with a stable course started the treatment when the neurologic deficit was not severe. We conclude that the efficacy of PE with other immunosuppressive therapies in the stabilization of the neurologic deficit is uncertain.
我们回顾性评估了血浆置换（PE）对7例患有副肿瘤性脑脊髓炎（PEM）、小细胞肺癌和抗Hu抗体的患者，以及4例患有副肿瘤性小脑变性（PCD）、卵巢癌或乳腺癌和抗Yo抗体的患者的疗效。除血浆置换外，患者还接受了泼尼松治疗（9例）、环磷酰胺治疗（8例）或肿瘤治疗（5例）。除1例患者外，所有患者在开始血浆置换时均严重残疾。将临床结果与5例仅接受肿瘤治疗的患者（4例PEM，1例PCD）进行比较。这5例患者中只有1例在抗肿瘤治疗开始时存在严重神经功能缺损。没有患者病情改善。2例接受血浆置换和抗肿瘤治疗的患者以及3例仅接受肿瘤治疗的患者至少6个月病情稳定。5例病情稳定的患者中有4例在神经功能缺损不严重时开始治疗。我们得出结论，血浆置换与其他免疫抑制疗法在稳定神经功能缺损方面的疗效尚不确定。
