目的:这项工作旨在报告两个新的非副肿瘤性抗Hu相关肠动力损害病例的人口统计学和临床特征,并进行彻底的修订,包括抗Hu相关副肿瘤(PGID)和非副肿瘤(nPGID)胃肠动力障碍。
背景:几个病例系列清楚地确定了某些类型癌症之间的关系,循环抗Hu抗体的发展,和伴随的通常严重的胃肠动力障碍;相比之下,一些研究集中在抗Hu相关nPGID上。
方法:我们搜索了有关抗Hu相关胃肠道表现的研究,并提取了有关患者临床特征的数据,包括具体的人口统计,肿瘤学,神经学,胃肠,组织学,和治疗反应特征。
结果:分析了49篇共59例抗Hu相关胃肠动力障碍。PGID和nPGID之间症状发作的患者年龄显着差异(中位数61岁vs31岁,p<0.001)。PGID中的大多数癌症(95%)是在胃肠道症状开始后24个月内检测到的。胃肠动力的损害是普遍的(即,涉及整个肠道)在59.3%的患者中,PGID与nPGID组之间无显着差异。nPGID患者对免疫调节/免疫抑制治疗的反应更好,预期寿命更长。
结论:抗Hu相关的胃肠动力障碍涵盖广泛的临床范围。其他原因不明的胃肠动力障碍患者,尤其是当与其他神经症状相关时,无论发病年龄和疾病持续时间,都应进行抗Hu抗体测试。与PGID相比,nPGID发生在疾病持续时间长的年轻患者中。
OBJECTIVE: This work aimed to report the demographic and clinical characteristics of two new cases with non-paraneoplastic anti-Hu-associated gut motility impairment, and perform a thorough revision covering anti-Hu-associated paraneoplastic (PGID) and non-paraneoplastic (nPGID) gastrointestinal dysmotility.
BACKGROUND: Several case series have clearly established a relationship between certain type of cancers, the development of circulating anti-Hu antibodies, and the concomitant usually severe gastrointestinal dysmotility; in contrast, a few studies focused on anti-Hu-associated nPGID.
METHODS: We searched for studies regarding anti-Hu-associated gastrointestinal manifestations and extracted data concerning clinical characteristics of patients, including specific demographic, oncological, neurological, gastrointestinal, histological, and treatment response features.
RESULTS: Forty-nine articles with a total of 59 cases of anti-Hu-associated gastrointestinal dysmotility were analyzed. The patients\' age at symptom onset significantly differed between PGID and nPGID (median 61 vs 31 years, p < 0.001). Most cancers (95%) in PGID were detected within 24 months from the beginning of gastrointestinal symptoms. The impairment of gastrointestinal motility was generalized (i.e., involving the whole gut) in 59.3% of patients, with no significant differences between PGID vs nPGID group. nPGID patients showed a better response to immunomodulatory/immunosuppressive treatment and a longer life expectancy.
CONCLUSIONS: Anti-Hu-associated gastrointestinal dysmotility covers a wide clinical spectrum. Patients with otherwise unexplained gastrointestinal dysmotility, especially when associated with other neurological symptoms, should be tested for anti-Hu antibodies regardless age of onset and disease duration. Compared to PGID, nPGID occurs in younger patients with a long duration of disease.