CAJ | 학술논문

目的分析肺癌相关副肿瘤性边缘叶脑炎(PLE)的临床特征和诊治要点.方法回顾性总结2000年1月到2010年5月收治的8927例肺癌患者的临床资料,根据2004年神经系统副肿瘤综合征欧洲工作网制定的PLE诊断标准,从中筛选出PLE患者共7例,均为男性,年龄41～ 54岁,平均48岁；分析其诊断、治疗及预后情况.结果 7例患者均有吸烟史.症状方面,7例均有不同程度的短期记忆力丧失,6例有癫痫发作,4例有不同程度的精神异常,2例合并抗利尿激素分泌不当综合征.肿瘤发现均依靠胸部X线片或CT检查.病理确诊主要依靠纤维支气管镜(5例),2例手术确诊；其中小细胞肺癌6例,肺腺癌1例.1例失访,6例随访4～21个月,平均11.5个月.治疗后神经系统症状完全缓解3例,部分缓解3例.3例死亡(生存期分别为4、10、14个月),肿瘤分期分别为Ⅳ期、Ⅲb期和Ⅲa期；3例随访中(随访时间分别为5、15、21个月),均为Ⅲa期,其中1例接受手术治疗及术后辅助化疗.结论 PLE为罕见疾病,熟悉疾病特点有助于早期诊断,抗肿瘤治疗能有效改善神经系统症状,神经系统症状缓解不完全以及肺癌分期偏晚可能与较差的预后相关.
목적 분석폐암상관부종류성변연협뇌염(PLE)적림상특정화진치요점.방법 회고성총결2000년1월도2010년5월수치적8927례폐암환자적림상자료,근거2004년신경계통부종류종합정구주공작망제정적PLE진단표준,종중사선출PLE환자공7례,균위남성,년령41～ 54세,평균48세；분석기진단、치료급예후정황.결과 7례환자균유흡연사.증상방면,7례균유불동정도적단기기억력상실,6례유전간발작,4례유불동정도적정신이상,2례합병항이뇨격소분비불당종합정.종류발현균의고흉부X선편혹CT검사.병리학진주요의고섬유지기관경(5례),2례수술학진；기중소세포폐암6례,폐선암1례.1례실방,6례수방4～21개월,평균11.5개월.치료후신경계통증상완전완해3례,부분완해3례.3례사망(생존기분별위4、10、14개월),종류분기분별위Ⅳ기、Ⅲb기화Ⅲa기；3례수방중(수방시간분별위5、15、21개월),균위Ⅲa기,기중1례접수수술치료급술후보조화료.결론 PLE위한견질병,숙실질병특점유조우조기진단,항종류치료능유효개선신경계통증상,신경계통증상완해불완전이급폐암분기편만가능여교차적예후상관.
Objective To analyze the clinical features,diagnosis and treatment of lung cancer associated paraneoplastic limbic encephalitis (PLE).Methods The clinical data of 7 cases of patients with lung cancer associated PLE out of 8927 patients of lung cancer from January 2000 to May 2010 was analyzed retrospectively.All the patients were male,aging from 41 to 54 years with a mean of 48 years.The data including history,physical examination,laboratory tests,diagnosis,treatment and follow-up were collected and analyzed.Results All the 7 patients had smoking history.All 7 patients had varying shortterm memory loss,6 had epilepsy,4 had different degrees of mental disorders,and 2 had syndrome of inappropriate secretion of antidiuretic hormone.Malignancies were screened and detected by chest X-ray or CT scan,while the pathological diagnoses were obtained through biopsy or transbronchial needle aspiration through electronic bronchoscope (5/7),biopsy of supraclavicular lymph nodes (1/7) and open pulmonary lobectomy (1/7).The pathological diagnosis included small cell lung cancer in 6 cases,adenocarcinoma of lung in 1 case.During the follow-up,1 patient was lost,and the mean time of follow-up of the remaining 6 patients was about 11.5 months (ranged from 4 to 21 months).Four patients received early immunosuppressive treatment in terms of corticosteroids,only slight relief of neurological symptoms was seen in 2 patients.However,after chemotherapy (6/6),radiation (3/6),or surgical removal of the tumor (1/6),complete remission (3/6,with negative anti-Hu antibody) or partial remission (3/6,2 of whom with positive anti-Hu antibody) of neurological symptoms were observed.Till October 2010,3 patients with poorer tumor stag died (survival were 4,10,and 14 months respectively),while the other 3 patients with negative anti-Hu antibody and relative better tumor stag were still in the follow-up (the period were 5,15,and 21 months).Conclusions PLE is a rare disease.In comparison with immunosuppressive therapy,chemotherapy,radiation or surgical removal of the tumor could provide better remission of the neurological symptoms.Positive serum anti-Hu antibody,poorer tumor stag,and together with poorer response to treatments seem to indicate a poorer prognosis.