低钠血症与吉兰-巴雷综合征预后的相关性

The relationship between hyponatremia and the prognosis of Guillain-Barré syndrome

目的 探讨低钠血症是否为吉兰-巴雷综合征（Guillain-Barr6 syndrome,GBS）患者预后不良的重要因素.方法 以GBS急性期患者作为研究对象,以病情高峰期英国医学研究理事会制定的肌力测定法总分作为GBS患者病情等级评估的标准,将患者划分为轻、中、重型.GBS高峰期血清钠值＜ 135 mmol/L作为低钠血症的诊断标准.回顾性分析GBS患者低钠血症的患病率、危险因素及对GBS预后的影响.结果 455例GBS患者满足入组标准纳入本研究.其中轻、中及重型患者分别为178、100和177例.98例（21.5％） GBS患者发生了低钠血症.其中,重型GBS患者低钠血症的患病率为36.2％（64例）,明显高于轻（11.8％,21例）、中型（13.0％,13例）患者（x2=28.921,17.074;均P＜0.01）.多因素Logistic回归分析显示：年龄＞50岁（OR=2.013,95％ CI1.155～3.508,P=0.014）、面神经受累（OR =2.493,95％ CI l.423 ～4.369,P=0.001）及机械通气（OR=12.871,95％ CI5.484～30.207,P=0.001）是GBS患者低钠血症发病风险增加的重要相关因素.而低钠血症（OR=12.770,95％CI3.419 ～47.701,P=0.001）与延髓性麻痹（OR=3.391,95％CI1.182 ～ 9.733,P=0.023）是GBS患者急性期死亡的危险因素.结论 低钠血症作为GBS患者预后不良的重要相关因素,更容易发生于高龄、合并面神经及呼吸肌麻痹的GBS患者.

Objective To evaluate the incidence of hyponatremia in patients with Guillain-Barré syndrom （GBS） and to explore whether hyponatremia is an important predictor of poor outcome.Methods All 455 GBS patients met the inclusion criteria and were divided into three groups as mild,moderate and severe GBS according to Medical Research Council sumscore （MRC sumscore） at nadir.Hyponatremia is defined as serum sodium concentration below 135 mmol/L at nadir.The incidences of hyponatremia in GBS patients with different MRC sumscore were analyzed by x2 tests.Logistic regression models were performed to determine risk factors of hyponatremia and poor prognosis.Results Of all the 455 GBS patients,mild,moderate and severe groups patients were 178,100 and 177 respectively,and 98 （21.5％） GBS patients had hyponatremia.Hyponatremia was more often detected in severe GBS cases （64,36.2％）,than in mild （21,11.8％） or moderate （13,13.0％,x2 =28.921,17.074 respectively; all P ＜ 0.01） cases,but there was no significant difference between mild and moderate patients （x2 =0.086 ; P =0.769）.Logistic regression analysis identified 3 predictors of hyponatremia：age ＞ 50 （OR =2.013,95％ CI 1.155-3.508,P =0.014）,facial weakness （OR =2.493,95％ CI 1.423-4.369,P =0.001） and mechanical ventilation （OR =12.871,95％ CI 5.484-30.207,P =0.001）.The presence of hyponatremia （OR =12.770,95％ CI3.419-47.701,P =0.001） and bulbar weakness （OR =3.391,95％ CI 1.182-9.733,P =0.023）predicted death in acute stage.Conclusion As an important predictor of poor outcome in GBS patients,hyponatremia is more likely occurred in patients with older age,facial weakness or respiratory failure.