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[与恶性肿瘤相关的自身免疫性脑炎]

[Autoimmune Encephalitis Associated with Malignant Tumors].

作者信息

Inuzuka Takashi

机构信息

Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine.

出版信息

Brain Nerve. 2016 Sep;68(9):1049-1055. doi: 10.11477/mf.1416200551.

Abstract

Autoimmune encephalitis consists of limbic symptoms and signs associated with antibodies against neuronal cell-surface antigens or intracellular antigens. Some cases are known to be associated with anti-channel or anti-receptor-related molecule antibodies. Whether these cases are paraneoplastic depends on the kinds of antigens that the antibodies are produced against. Other cases due to well-characterized onco-neural antibodies are almost always paraneoplastic and are generally resistant to anti-tumor therapy and/or immunotherapy. An exception is anti-Ma2 antibody-positive encephalitis associated with a testicular tumor. Antibodies for intracellular antigens are considered not to be pathogenic. Rather, the T-cell response is thought to be responsible. These antibodies are useful markers for the diagnosis of paraneoplastic disorders and in the search for underlying cancer, as neurological symptoms often precede tumor diagnosis. There is a relationship among onco-neural antibodies, clinical features, tumor types, and response to immunotherapy. Here we describe the characteristics of autoimmune encephalitis cases with antibodies against different intracellular antigens, such as Hu, Ma2, CRMP5, or amphiphysin.

摘要

自身免疫性脑炎由与抗神经元细胞表面抗原或细胞内抗原的抗体相关的边缘系统症状和体征组成。已知一些病例与抗通道或抗受体相关分子抗体有关。这些病例是否为副肿瘤性取决于抗体所针对的抗原种类。其他由特征明确的肿瘤神经抗体引起的病例几乎总是副肿瘤性的,并且通常对抗肿瘤治疗和/或免疫治疗耐药。一个例外是与睾丸肿瘤相关的抗Ma2抗体阳性脑炎。针对细胞内抗原的抗体被认为无致病性。相反,T细胞反应被认为起作用。这些抗体是诊断副肿瘤性疾病和寻找潜在癌症的有用标志物,因为神经症状往往先于肿瘤诊断出现。肿瘤神经抗体、临床特征、肿瘤类型和对免疫治疗的反应之间存在关联。在此,我们描述具有抗不同细胞内抗原(如Hu、Ma2、CRMP5或 amphiphysin)抗体的自身免疫性脑炎病例的特征。

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