儿童吉兰-巴雷综合征自主神经功能紊乱临床分析

Analysis of autonomic nervous dysfunction in childhood Guillain-Barre syndrome

目的探讨儿童吉兰-巴雷综合征(GBS)自主神经功能紊乱的发病情况及其与疾病严重程度的关系。方法回顾性分析2009-2011年郑州市儿童医院收治的资料完整的26例GBS患儿病例,男14例,女12例。对26例患儿进行Hughes评价量表分级,并对患儿神经症状、住院时间、神经电生理测试结果、脑脊液(CSF)结果进行分析。结果本组26例患儿中高血压18例(69%),心动过速20例(77%),同时有高血压和心动过速17例。高血压和(或)心动过速患儿Hughes分级高于血压正常和(或)心率正常患儿。高血压和心动过速患儿住院时间较血压和心率正常患儿明显延长,CSF中蛋白水平明显增高,差异均有统计学意义(P<0.05)。24例患儿进行神经电生理检测,其中急性脱髓鞘性多发性神经病21例,运动性轴索神经病2例,正常1例。24例患儿静脉用丙种球蛋白400mg/(kg.d)3～5d,1例行血浆置换,1例仅接受支持治疗,均取得良好早期疗效。结论 GBS患儿自主神经功能紊乱主要表现为高血压和心动过速,且其程度与疾病严重程度相关。

Objective To explore the incidence of autonomic nervous dysfunction in childhood Guillain-Barre syndrome （GBS）, and its relationship w4th disease severity. Methods Clinical data of 26 cases of GBS patients in Children＇s Hospital of Zhengzhou from 2009 to 2011 were retrospectively analyzed, in which 14 cases were male and 12 cases were female. All the children were classified with Hughes assessment scale and their neurosis symptoms, hospital days, the results of nerve electro physiology test and cerebrospinal fluid（CSF） were analyzed. Results Of the 26 children, 18 cases with hypertension （69%）, 20 cases with tachycardia （77%）, 17 cases both with hypertension and tachycardia. Compared with the children with normal blood pressure or heart rates, the Hughes grades of those with hypertension and （or） tachycardia were significantly higher, hospitalization days was longer and the CSF protein was increased（P〈0.05）. Twenty-four cases were tested by electromyogram nervous electrophysiology, in which 21 cases with acute demyelinating polyneuropathy, 2 cases with neurophysiologieal features consistent with motor axonal polyneuropathy and 1 case was normal. Twenty-four cases were treated with gamma glob ulin （400 mg·kg^-1·d^-1） for 3-5 days, 1 case with plasma exchange, 1 case with support therapy only, all the cases had good early efficacy. Conclusion Hypertension and tachycardia are the mainly presented of autonomic nervous dysfunction in childhood GBS, and its degree is correlated with disease severity.