大剂量丙种球蛋白治疗吉兰-巴雷综合征相关因素分析

Prognostic factors of Guillain-Barrésyndrome after intravenous immunoglobulin

目的探讨影响大剂量丙种球蛋白(IVIg)治疗吉兰-巴雷综合征疗效的因素,寻找应用大剂量IVIg治疗效果欠佳的原因。方法回顾性分析作者医院2006-01-2013-07期间住院的71例应用IVIg冲击治疗吉兰-巴雷综合征患者的临床资料及影响疗效的可能因素。分析的项目包括发病年龄、治疗前病情的严重程度(Hughes评分)、发病前感染史、合并肺部感染、脑神经受累、呼吸肌受累、治疗前脑脊液蛋白细胞分离情况、合并激素冲击治疗、使用IVIg距发病的时间。结果单因素分析结果显示合并肺部感染(P=0.001),呼吸肌受累(P=0.041)、IVIg治疗距发病时间>2周(P=0.003)是影响IVIg治疗效果的因素。将以上因素引入Logistic回归模型进行多因素Logistic回归分析发现,肺部感染(P=0.001,OR=10.561)、使用丙种球蛋白距发病的时间>2周(P=0.003,OR=6.822)为应用IVIg治疗效果欠佳的独立危险因素。结论吉兰-巴雷综合征合并肺部感染时采用IVIg治疗效果可能欠佳。早期积极控制肺部感染、发病2周内尽早采用IVIg治疗可能是提高IVIg治疗吉兰-巴雷综合征效果的有效途径。

Objective To examine the prognostic factors of Guillain-Barré syndrome after intravenous immunoglobulin and detect the reasons for ineffective intravenous immunoglobulin therapy.Methods A total of 71 Guillain-Barré syndrome patients were analyzed after intravenous immunoglobulin.Age at onset of Guillain Barré syndrome,severity of the disease before treatment,infectious histories,pulmonary infections,cranial nerves involvement,respiratory insufficiency,albuminocytologic dissociation in cerebrospinal fluid,combined high-dose methylprednisolone,and the duration between the onset of Guillain-Barré syndrome and intravenous immunoglobulin treatment were collected retrospectively.Results Univariate analysis showed that pulmonary infections （P=0.001）,duration more than two weeks between disease onset and intravenous immunoglobulin treatment （P =0.003） were all influencing factors of intravenous immunoglobulin efficiency.However,the analysis of multivariate logistic regression revealed that pulmonary infections （P =0.001,OR =10.561） and duration more than two weeks between disease onset and intravenous immunoglobulin （P=0.003,OR=6.822）were the independent risk factors of intravenous immunoglobulin inefficiency.Conclusions Intravenous immunoglobulin is ineffective in Guillain-Barré syndrome with pulmonary infections or after the first two weeks.Control of pulmonary infections and start the treatment within the first two weeks may improve the response to intravenous immunoglobulin.