Zalewski Nicholas L, Lennon Vanda A, Lachance Daniel H, Klein Christopher J, Pittock Sean J, Mckeon Andrew
Department of Neurology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Muscle Nerve. 2016 Aug;54(2):220-7. doi: 10.1002/mus.25027. Epub 2016 Feb 8.
Voltage-gated calcium-channel autoimmunity (VGCC-P/Q and VGCC-N types) occurs beyond Lambert-Eaton syndrome and lung cancer.
We reviewed records for 236 Mayo Clinic patients with VGCC antibodies found in evaluation for paraneoplastic neurological autoimmunity (generally without myasthenic syndromes).
VGCC autoantibodies were detected in 3.4% of neurological patients, 1.7% of healthy controls, and 4% of neurologically asymptomatic lung cancer controls. Fifty neurological patients (21%) had ≥ 1 neoplasm, historically (46) or detected prospectively [small-cell lung carcinoma (2), breast adenocarcinoma (2), lymphoma (1), and suspected tonsillar carcinoma (1)]. Autoimmune neurological diagnosis frequencies (encephalopathy, ataxia, myelopathy, neuropathy, neuromuscular junction disorder, and myopathy) among patients with medium values (24%; 0.10-0.99 nmol/L) or low values (19%; 0.03-0.10 nmol/L) were fewer than among patients with antibody values exceeding 1.00 nmol/L (71%; P = 0.02 and 0.004, respectively).
Among neuronal VGCC-autoantibody-seropositive patients, autoimmune neurological phenotypes and cancer types are diverse. Cautious interpretation of results (particularly medium and low values) is advised. Muscle Nerve, 2016 Muscle Nerve 54: 220-227, 2016.
电压门控钙通道自身免疫性疾病(VGCC-P/Q型和VGCC-N型)不仅见于兰伯特-伊顿综合征和肺癌。
我们回顾了梅奥诊所236例在副肿瘤性神经自身免疫性疾病评估中发现有VGCC抗体的患者记录(一般无肌无力综合征)。
在3.4%的神经科患者、1.7%的健康对照者和4%的无神经症状的肺癌对照者中检测到VGCC自身抗体。50例神经科患者(21%)既往(46例)或前瞻性检测到[小细胞肺癌(2例)、乳腺腺癌(2例)、淋巴瘤(1例)和疑似扁桃体癌(1例)]≥1种肿瘤。抗体值中等(24%;0.10 - 0.99 nmol/L)或低(19%;0.03 - 0.10 nmol/L)的患者中自身免疫性神经诊断频率(脑病、共济失调、脊髓病、神经病、神经肌肉接头疾病和肌病)低于抗体值超过1.00 nmol/L的患者(71%;P分别为0.02和0.004)。
在神经元VGCC自身抗体血清阳性患者中,自身免疫性神经表型和癌症类型多样。建议谨慎解读结果(尤其是中等和低抗体值)。《肌肉与神经》,2016年 肌肉与神经54: 220 - 227,2016年