| 郑新卉,金硕果,张耀丹,等.双重抗神经元抗体阳性的副肿瘤性自身免疫性脑炎合并小细胞肺癌 1例及文献复习[J].安徽医药,2026,30(7):1412-1418. |
| 双重抗神经元抗体阳性的副肿瘤性自身免疫性脑炎合并小细胞肺癌 1例及文献复习 |
| Paraneoplastic autoimmune encephalitis complicated with small cell lung cancer with positive double anti-neuronal antibodies: a case report and literature review |
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| DOI：10.3969/j.issn.1009-6469.2026.07.028 |
| 中文关键词: 神经系统自身免疫疾病 脑炎 癫痫 小细胞肺癌 副肿瘤综合征 免疫治疗 |
| 英文关键词: Autoimmune diseases of the nervous system Encephalitis Epilepsy Small cell lung cancer Paraneoplastic syndrome Immunotherapy |
| 基金项目:四川省自然科学基金项目( 24NSFSC5633)；四川省中医药管理局科学技术研究专项( 2023MS113) |
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| 中文摘要: |
| 目的探索双抗体阳性的副肿瘤性自身免疫性脑炎合并小细胞肺癌伴脑转移、脾转移的早期诊断和治疗经验。方法报告 2023年 3月至 2024年 1月成都中医药大学附属医院收治的 1例双抗体阳性的副肿瘤性自身免疫性脑炎合并小细胞肺癌病例，总结该病早期识别、诊治方法和出现癫痫持续状态、重症肺炎、感染性休克等并发症的诊疗方案。结果病人以眩晕为首发症状，入院后以多种形式的癫痫发作、认知障碍以及精神行为改变为主要表现。根据病人抗神经元抗体阳性、正电子发射计算机体层成像(PET/CT)以及免疫组化分析结果，诊断为副肿瘤性自身免疫性脑炎合并小细胞肺癌。治疗上采用静脉注射甲泼尼龙琥珀酸钠 1g，连续 5d，改为口服糖皮质激素序贯治疗，口服丙戊酸钠、左乙拉西坦片抗癫痫治疗，并制定了针对小细胞肺癌的 3期化疗方案。病人后因肿瘤转移、肺部感染后并发癫痫持续状态、感染性休克而去世。结论双抗体阳性的副肿瘤性自身免疫性脑炎病人临床表现复杂，预后较差。当怀疑副肿瘤性自身免疫性脑炎时，需早期广泛筛查抗神经元抗体，血清肿瘤标志物，长程脑电图以及 PET/CT等，并与副肿瘤综合征相鉴别。一旦确诊为副肿瘤性自身免疫性脑炎，应尽早启动免疫治疗、抗癫痫治疗、肿瘤化疗等综合治疗，并联合多学科合作制定合适的治疗方案以及长期随访共同延缓病情进展，改善病人的临床预后和晚期生存质量。 |
| 英文摘要: |
| Objective To explore the early diagnosis and treatment experience of paraneoplastic autoimmune encephalitis with dou-ble antibody positivity, accompanied by small cell lung cancer with brain and spleen metastases.Methods A case report of paraneo-plastic autoimmune encephalitis with double antibody positivity, combined with small cell lung cancer admitted to the Affiliated Hospi-tal of Chengdu University of Traditional Chinese Medicine from March 2023 to January 2024, summarizing the early identification, di-agnosis, and treatment methods, as well as the management plan for complications such as status epilepticus, severe pneumonia, andseptic shock.Results The patient's initial symptom was vertigo, and after admission, the primary manifestations were various forms ofepileptic seizures, cognitive impairment, and changes in mental behavior. Based on the positive anti-neuronal antibodies, positron emis-sion tomography-computed tomography (PET/CT) imaging, and immunohistochemical analysis results, the patient was diagnosed withparaneoplastic autoimmune encephalitis complicated by small cell lung cancer. The treatment regimen included intravenous injectionof methylprednisolone sodium succinate at 1 g for 5 consecutive days, followed by a switch to oral glucocorticoid treatment, oral sodiumvalproate, and levetiracetam tablets for antiepileptic therapy, and a phase Ⅲ chemotherapy plan targeting small cell lung cancer was de-veloped. Unfortunately, the patient passed away due to tumor metastasis, complications of status epilepticus following a pulmonary in-fection, and septic shock, resulting in a poor prognosis.Conclusions Patients with double antibody positive paraneoplastic autoim-mune encephalitis have complicated clinical manifestations and poor prognosis. When suspecting paraneoplastic autoimmune encepha-litis, it is necessary to conduct an early and comprehensive screening for anti-neuronal antibodies, serum tumor markers, long-term elec-troencephalogram (EEG), PET/CT and to differentiate it from paraneoplastic syndromes. Once diagnosed with paraneoplastic autoim-mune encephalitis, comprehensive treatment such as immunotherapy, anti-epileptic therapy, and tumor chemotherapy should be initiat-ed as soon as possible, and multidisciplinary collaboration should be used to develop appropriate treatment plans and long-term follow-up to jointly delay disease progression and improve the patient's clinical prognosis and quality of life in the later stages. |
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