免疫抑制剂对26例周围神经系统副肿瘤综合征的动态作用分析

The dynamic effects on immunosuppressive therapy to 26 cases of paraneoplastic peripheral nerve disease

目的探讨免疫抑制治疗对副肿瘤性周围神经疾病相关抗体定量与临床症状评分的动态影响。方法对26例周围神经系统副肿瘤综合征患者进行规范化的免疫抑制剂治疗,在治疗前及治疗开始后1、4周、治疗结束后1周,治疗结束后3月五个时间点分别对患者血清抗-Hu抗体、抗-Yo抗体、抗-Ri抗体进行定量检测,同时采用神经症状评分(NSS)、神经残疾评分(NDS)、改良神经功能(mRS)评分评估患者临床症状,并与抗体变化率进行相关性分析。结果抗-Hu抗体(F=7.634,P=0.00)、抗-Yo抗体(F=6.21,P=0.00)、抗-Ri抗体(F=3.80,P=0.02)定量总体变化均具有明显差异;与治疗前比较,抗HU抗体在治疗开始1周后下降(t=3.70,P=0.01),但治疗结束后3月与治疗前比较无明显差异(t=1.00,P=0.33);mRS、NDS、NSS评分均在治疗后1周下降(mRS:t=2.37,P=0.03;NDS:t=2.58,P=0.02;NSS:t=3.39,P=0.00),但mRS评分(F=1.84,P=0.15)评分总体变化无明显差异,NDS(F=3.27,P=0.02)及NSS评分(F=4.89,P=0.01)总体变化有明显差异,NDS评分治疗结束后1周仍明显下降(t=2.22,P=0.04)。治疗前相关抗体的定量与神经症状评分无明显关系(P>0.05),治疗开始后1周mRS及NSS评分的变化率与抗RI抗体的变化率呈正相关(mRS:r=0.46,P=0.02;NSS:r=0.40,P=0.04),而治疗开始后4周mRS评分的变化率与抗RI抗体的变化率(r=0.45,P=0.02)也呈正相关,其他抗体的变化与治疗开始后神经功能评分变化均无明显关系(P>0.05),而治疗结束后1周及治疗结束后3月抗体的变化与神经功能评分的变化均无明显关系(P>0.05)。结论免疫抑制剂对系统副肿瘤周围神经综合征患者的抗体定量滴度及NDS、NSS症状评分方面具有一定的临床作用,与治疗结束后的长期作用无明显关系。

Objective To investigate the dynamic effect of the immunosuppressant on both paraneoplastic peripheral nerve disease related antibody titer and clinical symptom scores. Methods 26 cases of paraneoplastic peripheral nerve disease were received standardized immunosuppressant treatment,The serum antibodies of anti-Hu,anti-Yo and anti-Ri were quantitatively detected by ELISA method before treatment,one week during treatment,four weeks during treatment,one week after treatment and three months after treatment respectively. At the same time,the clinical symptoms were astimated with the Neurological Symptom Scale（ NSS）,Neurological Disability Scale（ NDS）,Modified Rankin Scale（ mRS）. Then to analysis correlation between the antibody titers and clinical symptoms on the change rate with the time of treatment. Results The overall changes on quantitative titer include of anti-Hu（ F =7. 634,P = 0. 00）,anti-Yo（ F = 6. 21,P = 0. 00）,and anti-Ri（ F = 3. 80,P = 0. 02） were statistically significant.Compared with before treatment,One weeks during the treatment,titer of anti Hu began to decline（ t = 3. 70,P =0. 01）,but three months after treatment titer changes were not statistically significant compared with before treatment（ t = 1. 00,P = 0. 33）. Clinical symptom assessment： mRS,NDS,NSS in one weeks during treatment were decreased significantly（ mRS： t = 2. 37,P = 0. 03; NDS： t = 2. 58,P = 0. 02; NSS： t = 3. 39,P = 0. 00） but the overall change on mRS（ F = 1. 84,P = 0. 15） was not statistically significant,the overall change on NDS（ F = 3. 27,P = 0. 02） and NSS（ F = 4. 89,P = 0. 01） was statistically significant,NDS,NSS in four weeks after treatment were decreased significantly compared with before treatment（ t = 2. 22,P = 0. 04）. Before treatment,There was no significant correlation between the titer of antibody and neurological symptom score（ P〉0. 05）. In one weeks during treatment,the change rates of mRS and NSS were correlated with the rate of anti-RI（ mRS： r = 0. 46,P = 0. 02; NSS： r = 0. 40,P = 0. 04）. In four weeks during treatment,the change rate of mRS was correlated with the rate of anti-RI（ r = 0. 45,P = 0. 02）. There was no significant correlation in change rate beteween other antibodies and neurological symptom score during treatment（ P〉0. 05）. There was no significant correlation in change rate beteween all antibodies and neurological symptom score after treatment（ P〉0. 05）. Conclusion Immunosuppressive therapy could effectively inhibit the titer of antibody and properly relieve clinical symptoms associated with paraneoplastic peripheral nerve disease. It＇s long-term effects after treatment was no significant correlation.