[作为免疫相关的不良事件的外围神经病和肌肉疾病]
1Department of Neurology, Keio University School of Medicine.
Brain and nerve = Shinkei kenkyu no shinpo
|May 14, 2024
概括
免疫检查点抑制剂 (ICI) 可以引起神经系统免疫相关不良事件 (irAEs),主要影响周围神经系统和神经肌肉结节. 这些事件,包括多根核神经病和严重骨髓灰质炎,需要仔细的诊断和管理.
科学领域:
- 神经学 神经学
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
背景情况:
- 使用免疫检查点抑制剂 (ICI) 的癌症治疗可以引发神经系统免疫相关不良事件 (irAEs).
- 神经性irrAEs主要影响外周神经系统和神经肌肉结节,而不是中枢神经系统.
- 这些事件呈现出一系列的临床表现,需要全面了解有效的患者护理.
研究的目的:
- 确定与ICI疗法相关的神经性IRAE的不同临床特征.
- 突出外围神经病变的患病率和严重程度,特别是多根性核细胞神经病变.
- 讨论诊断神经肌肉结合障碍和相关疾病,如心肌炎的复杂性.
主要方法:
- 对神经性IRAEs的临床表现和免疫机制的审查.
- 对ICI诱导的特定神经疾病的分析,包括多基核性神经病症,dysautonomia,myasthenia gravis和兰伯特-伊顿肌痛综合征.
- 识别潜在的生物标志物,如抗Kv1.4抗体.
主要成果:
- 神经性irrAEs经常涉及周围神经系统,多基核神经病是严重的表现,导致显著的肌肉衰弱.
- 免疫检查点抑制剂可以诱导肌肉脱节和神经肌肉结合障碍,如肌痛性肌痛症和兰伯特-伊顿肌痛性肌痛综合征.
- 潜在的致命性心肌炎可以与严重心肌发生并发,而抗Kv1.4抗体与这两种情况的严重形式有关. 兰伯特-伊顿肌痛综合征作为一种irAE与一种神经瘤综合征之间的区别仍然不清楚.
结论:
- 在接受ICI治疗的患者中,神经性irrAEs是一个重大问题,其特点是不同的外周和神经肌肉表现.
- 准确诊断诸如肌痛性肌痛症和兰伯特-伊顿肌痛性肌痛综合征等疾病至关重要,特别是当肌痛性心脏炎复杂时.
- 需要进一步的研究来澄清irAEs和神经瘤综合征之间的免疫重叠,特别是对于兰伯特-伊顿肌痛综合征.
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