癌症关联作为抗HMGCR抗体阳性肌病的一个风险因素。
Cancer association as a risk factor for anti-HMGCR antibody-positive myopathy.
作者信息
Kadoya Masato, Hida Ayumi, Hashimoto Maeda Meiko, Taira Kenichiro, Ikenaga Chiseko, Uchio Naohiro, Kubota Akatsuki, Kaida Kenichi, Miwa Yusuke, Kurasawa Kazuhiro, Shimada Hiroyuki, Sonoo Masahiro, Chiba Atsuro, Shiio Yasushi, Uesaka Yoshikazu, Sakurai Yasuhisa, Izumi Toru, Inoue Manami, Kwak Shin, Tsuji Shoji, Shimizu Jun
机构信息
Department of Neurology and Anti-aging Medicine (M.K., K. Kaida), National Defense Medical College, Saitama; Department of Neurology (A.H., K.T., C.I., N.U., A.K., S.K., S.T., J.S.), Graduate School of Medicine, The University of Tokyo; Department of Neurology (M.H.M., Y.U.), Toranomon Hospital; Division of Rheumatology (Y.M.), Department of Internal Medicine, Showa University School of Medicine, Tokyo; Pulmonary Medicine and Clinical Immunology (K. Kurasawa), Dokkyo Medical University, Tochigi; Department of Diagnostic and Interventional Radiology (H.S.), Osaka City University, Graduate School of Medicine; Department of Neurology (M.S.), Teikyo University School of Medicine; Department of Neurology (A.C.), Kyorin University; Department of Neurology (Y. Shiio), Tokyo Teishin Hospital; Division of Neurology (Y. Sakurai), Mitsui Memorial Hospital, Tokyo; Department of Neurology (T.I.), Tsukazaki Memorial Hospital, Hyogo; and AXA Department of Health and Human Security, Graduate School of Medicine (M.I.), The University of Tokyo, Japan.
出版信息
Neurol Neuroimmunol Neuroinflamm. 2016 Oct 7;3(6):e290. doi: 10.1212/NXI.0000000000000290. eCollection 2016 Dec.
OBJECTIVE
To show cancer association is a risk factor other than statin exposure for anti-3-hydroxy-3-methylglutaryl coenzyme A reductase autoantibody-positive (anti-HMGCR Ab+) myopathy.
METHODS
We analyzed the clinical features and courses of 33 patients (23 female and 10 male) with anti-HMGCR Ab+ myopathy among 621 consecutive patients with idiopathic inflammatory myopathies.
RESULTS
Among the 33 patients, 7 (21%) were statin-exposed and 26 were statin-naive. In relation with cancer, there were 12 patients (statin-exposed, n = 4) with cancers detected within 3 years of myopathy diagnosis (cancer association), 3 patients (all statin-naive) with cancers detected more than 3 years before myopathy diagnosis (cancer history), 10 cancer-free patients followed up for more than 3 years (all statin-naive), and 8 patients without cancer detection but followed up for less than 3 years (statin-exposed, n = 3). Therefore, 12 patients with cancer association (36%) formed a larger group than that of 7 statin-exposed patients (21%). Among 12 patients with cancer association, 92% had cancer detection within 1 year of myopathy diagnosis (after 1.3 years in the remaining patient), 83% had advanced cancers, and 75% died of cancers within 2.7 years. Of interest, 1 patient with cancer history had sustained increase in creatine kinase level over 12 years from cancer removal to the development of weakness.
CONCLUSIONS
Patients with cancer association formed a large group with poor prognosis in our series of patients with anti-HMGCR Ab+ myopathy. The close synchronous occurrence of cancers and myopathies suggested that cancer association is one of the risk factors for developing anti-HMGCR Ab+ myopathy.
目的
证明癌症关联是抗3-羟基-3-甲基戊二酰辅酶A还原酶自身抗体阳性（抗HMGCR Ab+）肌病除他汀类药物暴露之外的一个危险因素。
方法
我们分析了621例连续的特发性炎性肌病患者中33例（23例女性和10例男性）抗HMGCR Ab+肌病患者的临床特征和病程。
结果
在这33例患者中，7例（21%）曾使用他汀类药物，26例未使用过他汀类药物。关于癌症，有12例患者（曾使用他汀类药物的4例）在肌病诊断后3年内检测出癌症（癌症关联），3例患者（均未使用过他汀类药物）在肌病诊断前3年以上检测出癌症（癌症病史），10例无癌症患者随访超过3年（均未使用过他汀类药物），8例未检测出癌症但随访时间不足3年（曾使用他汀类药物的3例）。因此，12例有癌症关联的患者（36%）比7例曾使用他汀类药物的患者（21%）构成的群体更大。在12例有癌症关联的患者中，92%在肌病诊断后1年内检测出癌症（其余1例在1.3年后检测出），83%为进展期癌症，75%在2.7年内死于癌症。有趣的是，1例有癌症病史的患者从癌症切除到出现肌无力的12年中肌酸激酶水平持续升高。
结论
在我们的抗HMGCR Ab+肌病患者系列中，有癌症关联的患者构成了一个预后不良的大群体。癌症与肌病的紧密同步发生提示癌症关联是发生抗HMGCR Ab+肌病的危险因素之一。
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