Guillain-Barre综合征患者早期电生理检查的临床分析

Clinical Analysis of Early Electrodiagnostic Examination in Patients with Guillain-Barre Syndrome

目的回顾性研究Guillain-Barre综合征(GBS)患者发病早期电生理变化特点。方法选取2012年4月至2014年6月就诊于我院并最终确诊为GBS的患者,初始症状出现10 d内(包括10 d)且已进行电生理检查,共18例作为研究对象,对其电生理检查结果进行对比分析。结果初始症状出现后7 d及10 d内行电生理检查的结果显示,主要异常为H反射潜伏期延长(100%、90%)、DML延长(78%、90%)、F波异常包括出现率下降或消失、F波传导速度下降(61%、60%)、CAMP下降(50%、60%)、MNCV下降(33%、30%)、SNCV下降(28%、40%)。其中H反射的异常和DML的延长是最常见的异常。运动神经传导检测结果显示,腓总、胫神经的异常率高于正中、尺神经。结论 GBS发病早期,电生理检查的异常率非常高,H反射及F波是GBS早期诊断的敏感指标,建议针对可疑GBS患者应尽早行电生理检查,进行常规电生理检查时也应进行H反射及F波的检查。

Objective To retrospectively study the electrodiagnostic（EDX）abnormal features in early GBS patients. Methods The EDX recordings of all GBS patients conformed in our Neurology department from April 2012 to June 2014 were retrospectively reviewed. Patients diagnosed as GBS but no other disease by the clinical,imaging laboratory and EDX date were recruited for the study. We reviewed the EDX date of 18 GBS patients in whom EDX studies had been performed within 10 days after disease onset,and the results were compared. Results EDX abnormalities were observed in 18 patients within 7 days and10 days after disease onset. The most altered parameters were H-reflexes（100%,90%）,distal motor latencies,DML（78%,90%）,abnormal F-wave（61%,60%）,abnormal CAMP amplitudes（50%,56%）,abnormal MNCV（33%,30%）,abnormal SNCV（28%,40%）. H-reflex and DML were the most common abnormality. Abnormalities in motor nerves were more frequently found in tibial nerves,followed by peroneal,median and ulnar nerves. Conclusion EDX is always abnormal in early GBS. H-reflex and F-wave are the most sensitive indexes in the GBS early diagnosis. Our findings suggest that patients with suspected GBS should make EDX as soon as possible.