移植后的疼痛和:神经性骨髓缩是血造干细胞移植后肩部功能障碍的非典型原因
Franchesca König1, Chanel Davidoff2, Katarzyna Ibanez3
1Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
Cancers
|June 13, 2025
概括
神经性骨髓缩 (NA) 是血液造血干细胞移植 (HSCT) 后的一种罕见并发症. 早期怀疑,通过MRI和电诊断进行诊断,以及标准化的随访对于改善这些患者的治疗结果至关重要.
科学领域:
- 神经学 神经学
- 血液学 血液学 血液学
- 移植医学 移植医学
背景情况:
- 神经性缩 (NA),或帕森纳奇-特纳综合征,是一种罕见的外周神经疾病,导致急性肩部疼痛和运动缺陷.
- 虽然已知的神经复发症是血造细胞干细胞移植后 (HSCT),但在这种情况下,NA非常罕见.
- HSCT患者的发病可能涉及免疫失调,移植与宿主疾病,感染或免疫抑制疗法的影响.
研究的目的:
- 描述在HSCT后被诊断为NA的患者的临床表现,病程和结果.
- 识别HSCT人群中NA的关键诊断特征和潜在管理策略.
主要方法:
- 追溯的案例系列的九名患者在一个机构在HSCT后诊断出NA.
- 收集的数据包括人口统计,移植细节,临床特征,MRI和电诊断研究.
- 诊断是基于临床表现,由成像和电诊断发现支持;长期随访评估恢复.
主要成果:
- 九名患者在HSCT后发展了NA (自身n=4,异性n=5),疼痛发作中位数为移植后9天,主要是单侧右肩疼痛.
- 疼痛开始后出现神经系统衰弱和感官缺陷;MRI显示6例肌肉胀/缩/增强,EMG证实5例NA.
- 长期随访 (>1年) 显示,7名患者的部分或完全康复,其中2名患者的改善程度很小.
结论:
- 在呈现急性肩部疼痛和神经症状的HSCT患者中,应强烈怀疑NA.
- 建议加强临床医生的意识和有针对性的诊断协议 (MRI,电诊断) 以提高准确性.
- 标准化的长期随访协议对于监测和管理HSCT后的NA恢复至关重要.
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