吉兰-巴雷综合征患者神经电生理特点及其与机械通气、远期预后的相关性分析

Correlation Analysis between Electrophysiological Features and Mechanical Ventilation and Long-term Outcome in Patients with Guillain-Barré Syndrome

目的回顾性研究吉兰-巴雷综合征(GBS)患者神经电生理特点及其与机械通气、远期预后的相关性。方法收集2013年4月至2015年9月就诊于中国医科大学附属第一医院神经内科的38例GBS患者的神经电生理数据及临床资料,根据病程中是否接受机械通气分为上机组和未上机组;根据Hadden等的分型标准分为急性炎性脱髓鞘性多发神经根神经病(AIDP)、急性运动轴索性神经病(AMAN)和未分类组,分别比较组间神经电生理及临床特点。结果上机组腓总神经近端/远端复合肌肉动作电位波幅(p/d CMAP,48.7±15.3)比值明显低于非上机组(80.8±24.0,P=0.005),AIDP中接受机械通气的比例(46%)明显高于AMAN(0%)及未分类组(9%,P=0.027),AMAN的远期预后评分(4.3±1.3)明显低于AIDP(2.5±0.9,P=0.028)。结论神经电生理检查对机械通气及远期预后有预示作用,腓总神经p/d CMAP比值下降可以预测机械通气;AIDP患者更易发生呼吸衰竭,与AMAN患者相比预后不良。

Objective To study the correlation between the electrophysiological features and mechanical ventilation and long-term outcome in Guil- lain-Barre syndrome （GBS） patients. Methods Electrophysiological and clinical data were retrospectively collected, and compared between venti- lated and not ventilated patients, as well as among each subtype of GBS. Results Totally 38 GBS patients were included in the study, among which 12 （32%） were ventilated. The p/d CMAP ratio of the common peroneal nerve was significantly lower in ventilated group compared to not ventilated group （48.7±15.3 vs 80.8±24.0, P = 0.005）. AIDP was the most common subtype in ventilated patients compared with AMAN and undetermined （46% vs 0% and 9%, P = 0.027）. The long-term outcome score of AMAN was significantly lower than AIDP （4.3± 1.3 vs 2.5 ±0.9, P = 0.028）. Conclusion Electrophysiological testing was predictive for mechanical ventilation and long-term outcome ： low p/d CMAP ratio of the common pero- neal nerve was helpful for predicting mechanical ventilation, AIDP was prone to develop respiratory failure and had a worse outcome compared to AMAN.