58例吉兰-巴雷综合征临床特点分析

Clinical Characteristics of Guillain-Barre Syndrome:analysis of 58 cases

探讨吉兰-巴雷综合征的临床特点与预后。对湖南省人民医院神经内科2014年2月~2015年11月收治的58例吉兰-巴雷综合征的患者根据电生理特点主要分为AIDP型与AMAN型,根据患者的诱因、病情进展情况、脑脊液颅内压情况、治疗方法与预后等临床资料进行回顾性分析。58例患者中诱因不同,统计学意义不一样。其中,消化道感染在两组间存在统计学差异,而呼吸道感染在两组间无统计学差异。AIDP型患者较AMAN型患者预后好,AMAN型患者中以消化道感染为诱因者起病急,病情进展快,呼吸肌麻痹需机械通气治疗者多见,预后较差。同时发现患者中有一部分存在脑脊液颅内压增高现象,且AMAN型患者脑脊液颅内压增高的例数明显多于AIDP型患者,有统计学意义。结合患者诱因、病情进展情况、脑脊液实验室结果及电生理检查等对该疾病患者进行早期诊断、分型,尤其是AMAN型患者早期给予大剂量丙种球蛋白静滴中和相关抗体治疗是关键。

To investigate the clinical features and prognosis of Guillain-Barre syndrome （GBS）, 58 cases of GBS were divided into two groups： acute inflammatory demyelinating polyneuropathies （AIDP） group and acute motor axonal neuropathy （AMAN） group according to the electrophysiologic features. The clinical manifestations including inducement, disease progress, cerebrospinal fluid pressure, treatment and prognosis of the two groups were retrospectively analyzed. There was no significant difference in respiratory infection between the two groups. But there was significant difference in digestive tract infection between the two groups. The prognosis of eases in AIDP group is better. The cases in AMAN group with the inducement of digestive tract infection had acute onset and rapid progress, tended to mechanical ventilation on respiratory muscle paralysis, and had a poor prognosis. Intracranial hypertension had been found in some cases. The number of cases with intracranial hypertension in AMAN group was higher than that in AIDP group. There was statistical significant difference between the two groups. The prognosis of GBS was associated with electrophysiologic features, inducement, disease progress and cerebrospinal fluid pressure. Early diagnosis of GBS and early treatment with intravenous immunoglobulin for neutralizing related antibodies is the key to good prognosis, particularly in AMAN group.