Pelucchi A, Ciceri E, Clementi F, Marazzini L, Foresi A, Sher E
Servizio di Broncopneumologia e Fisiopatologia Respiratoria, G. Campari, Sesto S. Giovanni, Milan, Italy.
Am Rev Respir Dis. 1993 May;147(5):1229-32. doi: 10.1164/ajrccm/147.5.1229.
Lambert-Eaton myasthenic syndrome (LEMS) is one of the neurologic paraneoplastic syndromes often found in patients with lung cancer. It is characterized by a generalized deficit of neurotransmitter release. Patients with small cell lung cancer (SCLC) in particular may develop LEMS, and SCLC is very often detected in patients affected by LEMS. LEMS is an autoimmune disease, and autoantibodies that interfere with neurotransmitter release by binding to presynaptic voltage-operated calcium channels (VOCCs) have been found in sera of patients with LEMS. Both human neuronal and SCLC cell lines express omega-conotoxin-sensitive VOCCs, and autoantibodies from patients affected by LEMS can precipitate these channels. We have now screened a large population of patients and control subjects in order to define the specificity and sensitivity of the anti-VOCC antibody assay. We have tested sera from 52 patients with LEMS with and without SCLC; 32 sera from patients with SCLC without LEMS, 31 from patients with non-SCLC, 34 from patients with inflammatory lung diseases, 17 from patients with other neurologic disorders, and 48 from healthy control subjects. We have found that a positive result with this radioimmunoassay is highly specific for LEMS, with or without SCLC, when the antibody titer is higher than 14.21 pM. Anti-VOCC antibodies have also been found in about 40% of patients with SCLC without LEMS, but they were absent in all the other populations tested. We can conclude that this serologic assay is a very useful aid in the diagnosis of LEMS, and it might be useful also for the early diagnosis of SCLC.
兰伯特-伊顿肌无力综合征（LEMS）是一种常见于肺癌患者的神经副肿瘤综合征。其特征为神经递质释放普遍减少。尤其是小细胞肺癌（SCLC）患者可能会发生LEMS，而LEMS患者中也经常检测出SCLC。LEMS是一种自身免疫性疾病，在LEMS患者血清中发现了通过与突触前电压门控钙通道（VOCCs）结合而干扰神经递质释放的自身抗体。人类神经元细胞系和SCLC细胞系均表达对ω-芋螺毒素敏感的VOCCs，LEMS患者的自身抗体可使这些通道沉淀。我们现在对大量患者和对照受试者进行了筛查，以确定抗VOCC抗体检测的特异性和敏感性。我们检测了52例患有或未患有SCLC的LEMS患者的血清；32例未患有LEMS的SCLC患者的血清、31例非SCLC患者的血清、34例炎性肺病患者的血清、17例其他神经系统疾病患者的血清以及48例健康对照受试者的血清。我们发现，当抗体滴度高于14.21 pM时，这种放射免疫测定的阳性结果对患有或未患有SCLC的LEMS具有高度特异性。在约40%未患有LEMS的SCLC患者中也发现了抗VOCC抗体，但在所有其他检测人群中均未发现。我们可以得出结论，这种血清学检测对LEMS的诊断非常有用，对SCLC的早期诊断可能也有用。
