BRAIN and NERVE－神経研究の進歩62巻4号

2010年04月発行

特集 傍腫瘍性神経筋疾患update

悪性腫瘍関連筋炎

著者： 清水潤¹

所属機関： ¹東京大学医学部附属病院神経内科

ページ範囲：P.427 - P.432

文献概要

はじめに

　筋炎は自己免疫性炎症機序により筋組織が破壊される病態であり，古典的には皮膚症状の有無から大きく多発筋炎（polymyositis：PM），皮膚筋炎（dermatomyositis：DM）に分類されるが^1），臨床像と組織所見の検討^2）や，合併膠原病のタイプおよび出現する自己抗体の検討^3）から，さまざまな病態機序を背景に持つheterogeneousな疾患であることが明らかにされつつある。一方，1世紀近く前より，筋炎の一部の症例に悪性腫瘍が合併し特徴的な臨床像を示すとして多くの報告がなされてきた。しかしながら，両者の関連を明確にする疫学検討がなされたのは，近年になってからである。また，最近，悪性腫瘍関連筋炎症例に高頻度で出現する抗体として，抗p155/p140抗体（抗p155抗体）が発見された。本抗体は悪性腫瘍を伴う特発性筋炎の診断に役立つばかりでなく，本疾患の病態機序を考えるうえでも重要である。本稿では，悪性腫瘍関連筋炎の疫学および臨床的な特徴について概説し，現時点での本疾患の病態機序に関する仮説を紹介する。

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