急性运动轴索型神经病的预后分析

Prognostic analysis of acute motor axonal ncuropathy

目的 研究吉兰-巴雷综合征（GBS）的临床特征，分析比较急性炎性脱髓鞘型多神经病（AIDP）和急性运动轴索型神经病（AMAN）的预后。方法分析卫生部北京医院神经科自2003年1月至2007年12月收治的50例GBS患者临床资料，根据电生理分型诊断标准将患者分为AIDP组（24例）与AMAN组（22例），不能分类4例，对出院时仍不能独立行走的患者至少随访6个月，分析比较两组患者的临床特征和预后。结果AIDP与AMAN两组患者的性别、年龄、颅神经受累情况、就诊及高峰时的病情评级、接受的治疗方法等比较差异无统计学意义（P〉0．05）：治疗1个月时患者Hughes运动功能评级两组间比较差异无统计学意义（P〉0．05）；而AMAN组患者快速恢复、缓慢恢复的比例（63％，18％）均高于AIDP组（33％，4％），差异均有统计学意义（P〈0．05）。结论AMAN患者临床上存在快速恢复与缓慢恢复两种情况；对AMAN患者应予积极免疫治疗，以获早期恢复和较好预后。

Objective To investigate the clinical features of Guillain-Barr6 syndrome （GBS） and clarify the long-term prognosis of acute inflammatory demyelinating polyneuropathy （AIDP） and acute motor axonal neuropathy （AMAN）. Methods We conducted an analysis of the clinical data of 50 patients with GBS treated in our hospital between 2003 and 2007. According to the electrophysiological criteria, the cases were classified into AIDP （n=24） and AMAN cases （n=22）, with 4 cases of unknown classification. The patients unable to walk upon discharge were followed up for more than 6 months, and the clinical features and prognosis of the two groups were compared. Results The age, gender, cranial nerve involvement, Hughes grade at the initial neurological examination and at the time of symptom peak did not differ significantly between the patients with AIDP and AMAN （P〉0.05）, and most of the AMAN patients had a good recovery. The number of patients capable of walking at one month aider the onset was comparable between the two groups （/：＇〉0.05）. In AMAN group, the percentages of patients with slow recovery and those having rapid recovery were significantly higher than those in AIDP group （P〈0.05）. Conclusion The clinical recovery of AMAN patients can be either rapid or prolonged, and rigorous immunotherapy should be administered to achieve early recovery and ensure more favorable outcomes of the patients.