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累及周围神经及肌肉的副癌综合征

Authors
Josep Dalmau, MD, PhD
Myrna R Rosenfeld, MD, PhD
Section Editor
Jerome B Posner, MD
Deputy Editor
April F Eichler, MD, MPH
Translators
孟长婷, 主治医师

引言

神经副癌综合征是一组不同的神经系统疾病，与全身肿瘤有关，其发生机制不同于肿瘤转移、代谢缺陷和营养缺乏、感染、凝血功能障碍以及癌症治疗的副作用。这些综合征可能累及神经系统的任何部位(大脑皮层到神经肌接头和肌肉)，损伤一个或多个区域。

本专题将总结累及周围神经及肌肉的副癌综合征。副癌综合征的概述及其他副癌性疾病将单独讨论。 (参见“神经系统副肿瘤综合征概述”和“累及脊髓和后根神经节的副肿瘤综合征”和“副肿瘤性小脑变性”和“副肿瘤性和自身免疫性脑炎”和“副肿瘤性视觉综合征”)

周围神经综合征

亚急性感觉神经病变 — 亚急性感觉神经病变将单独讨论。 (参见“累及脊髓和后根神经节的副肿瘤综合征”，关于‘亚急性感觉神经元病’一节)

慢性感觉运动性神经病 — 慢性感觉运动性神经病在癌症患者中很常见。约10%-15%的实体瘤患者出现临床上明显的副癌感觉运动性神经病[1,2]，而多达35%-50%的患者存在电诊断检查上的亚临床异常[3]。症状通常出现在诊断为恶性肿瘤后很久的晚期疾病患者中，大多数受累患者都存在肺癌。有人认为慢性感觉运动性神经病可能是一种营养性病变[4]。

慢性感觉运动性神经病患者并不因其神经系统症状而严重影响常规活动能力，这些神经系统症状通常包括轻到中度的远端对称性神经运动障碍。其神经传导检查结果与轴突神经病变相符，但也可能观察到传导速度下降，例如脱髓鞘。鉴别诊断包括癌症治疗的副作用以及与恶性肿瘤无关的疾病(如糖尿病、酒精中毒和维生素B12缺乏)。在一些患者中可以检测到抗神经节苷脂抗体，但由于该抗体也可见于非副癌神经病患者，所以其临床意义尚不明确[5]。

                   

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Literature review current through: 2017-06 . | This topic last updated: 2015-10-26.
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