检测副肿瘤神经抗体的临床意义

Clinical significance of paraneoplastic neurological antibodies detection

副肿瘤综合征（PNS）是指机体各系统的恶性肿瘤产生的远隔效应所致的中枢神经系统、周围神经、神经肌肉接头处或肌肉的病变。许多PNS因肿瘤诱发出现与神经抗原相关的抗体即副肿瘤神经抗体。根据靶抗原的位置和抗体免疫反应机制的不同将副肿瘤神经抗体分为两组，Ⅰ组是靶抗原在细胞内、T细胞免疫应答介导的抗体；Ⅱ组是靶抗原在神经元表面、B细胞免疫应答介导的抗体。这些副肿瘤神经抗体是有助于诊断PNS的标志物，而且，在一些病例中，可能揭示隐匿发生的恶性肿瘤。此外，抗体的类型还可提示对免疫治疗的反应差异，Ⅱ组抗体的免疫治疗反应更好。

Paraneoplastic neurological syndromes （PNS） were defined as neurological syndromes associated with cancer. In many cases, autoantibodies against neural antigens expressed by the tumor （paraneoplastic neurological antibody or onconeural antibodies） were detected. The neuronal antibodies, which were associated with syndromes resulting from central nervous system neuronal dysfunction, were classified into two groups according to the location of the antigen ： inside the neuron or in the cell membrane. Group Ⅰ antibodies targeted on intracellular antigens and were predominantly dependent on T-cell-mediated responses. Group Ⅱ antibodies recognized neuronal surface antigens and were predominantly dependent on B-cell-mediated responses. Onconeural antibodies were useful diagnostic markers of the brain disease, and in some cases, they might reveal an underlying malignancy. Moreover, the presence of antibodies against surface（group Ⅱ ） antigens might predict a more favorable response to immunotherapy than that against intracellular （group Ⅰ ） antigens.