肿瘤免疫治疗相关外周神经病变的研究进展

doi:10.16138/j.1673-6087.2025.05.08

摘要/Abstract

摘要：

随着肿瘤免疫治疗的快速发展，免疫检查点抑制剂（immune checkpoint inhibitor, ICI）和嵌合抗原受体T细胞（chimeric antigen receptor T-cell, CAR-T）疗法等免疫治疗在癌症治疗中的广泛应用，其相关神经毒性也引发关注，称为神经免疫相关不良事件（neurologic immune-related adverse event, n-irAE）。免疫治疗通过激活宿主免疫系统识别并清除肿瘤细胞，显著提高某些患者的长期生存率。然而，免疫系统的过度激活也可能导致一系列非靶向器官免疫相关不良事件（immune-related adverse event, irAE），其中神经系统受累虽相对少见，却具有高度异质性与潜在严重后果。外周神经病变（peripheral neuropathy, PN）是其重要且潜在致残的表现。该类病变临床表现多样，包括多发性神经病、吉兰-巴雷综合征、神经根病及痛觉异常等，其发病机制尚未完全阐明，可能涉及免疫失衡、自身抗体、炎症因子及个体遗传易感等。本文综述近年来有关肿瘤免疫治疗相关PN的临床特征、发病机制、诊断及治疗进展，以期为临床早期识别和干预提供参考。

关键词: 肿瘤, 免疫治疗, 外周神经病变, 流行病学

Abstract:

With the rapid development of tumor immunotherapy, the widespread clinical application of immune checkpoint inhibitor (ICI) and chimeric antigen receptor T-cell (CAR-T) therapy has raised concerns about their associated neurotoxicity, which is known as neurologic immune-related adverse event (n-irAE). Immunotherapy significantly improves long-term survival rate of some patients by enhancing the host immune system’s ability to recognize and eliminate tumor cells. However, overactivation of the immune system can also lead to a range of immune-related adverse event (irAE) affecting non-tumor organs. Although neurological involvement is relatively uncommon, it is highly heterogeneous and can cause severe consequences. Peripheral neuropathy (PN) is one of the most important and potentially disabling manifestations. The clinical presentations of PN are diverse, including polyneuropathy, Guillain-Barré syndrome, radiculopathy, and sensory disturbances. The underlying pathogenesis is not fully understood but may involve immune dysregulation, autoantibodies, inflammatory cytokines, and individual genetic susceptibility. This review summarizes recent advances in the clinical features, pathogenesis, diagnosis, and treatment of PN associated with cancer immunotherapy, aiming to provide insights for early clinical recognition and intervention.

Key words: Cancer, Immunotherapy, Peripheral neuropathy, Epidemiology

中图分类号:

R730.51
R741

张姚, 韩婷, 王宇, 王春艳, 肖秀英. 肿瘤免疫治疗相关外周神经病变的研究进展[J]. 内科理论与实践, 2025, 20(05): 388-392.

ZHANG Yao, HAN Ting, WANG Yu, WANG Chunyan, XIAO Xiuying. Research progress on peripheral neuropathy related to tumor immunotherapy[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(05): 388-392.

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