重型吉兰-巴雷综合征合并呼吸衰竭患者临床危险因素和长期预后分析

The clinical risk factors and long-term prognostic analysis of severe Guillain-Barrésyndrome with respiratory failure

目的探讨重型吉兰-巴雷综合征(GBS)合并呼吸衰竭(RF)的临床危险因素,分析影响其短期预后和长期预后的危险因素。方法收集2006-7—2016-3年北京博爱医院收治的62例重型GBS病例,分为RF组〔休斯功能分级量表(HFGS)=5分〕和非RF组(HFGS=4分),应用Logistic回归分析重型GBS出现RF的独立临床危险因素。根据发病3个月后的HFGS分为功能恢复良好组(HFGS<3分)和功能恢复不良组(HFGS≥3分),分析影响重型GBS短期预后(发病3个月)和长期预后(发病1年)的临床因素。结果共62例重型GBS患者,RF组25例,非RF组37例。发病1周内达峰者出现RF风险是达峰时间超过1周患者的2.957倍(OR=3.957,95%CI:1.141~13.724,P=0.030)。合并自主神经功能障碍者出现RF风险是无自主神经功能障碍者的3.259倍(OR=4.259,95%CI:1.306~13.890,P=0.016)。两组间首发症状为脑神经受累比例比较差异有统计学意义(P<0.05),但不是重型GBS合并RF的独立危险因素。预后方面,38.7%患者在发病3个月可独立行走,74.4%患者在发病1年可独立行走。与脱髓鞘型GBS比较,轴索型GBS增加发病3个月至1年功能恢复不良的风险约6~22倍。发病时存在感觉障碍减少发病3个月至半年功能恢复不良的风险约73%~77%,但在发病后1年,感觉障碍对功能恢复的影响下降,年龄大的患者轻度增加功能预后不良的风险。结论病情迅速进展、合并自主神经功能障碍的GBS患者更易出现RF。近3/4的重型GBS发病1年后能独立行走,其中轴索型、年龄大的患者长期预后相对较差。

Objective To explore the clinical risk factors of severe Guillain-Barrésyndrome（GBS）with respiratory failure（RF）,and analysis the risk factors affecting the short-term and long-term prognosis.Methods Sixty-two patients with severe GBS admitted to Beijing Bo＇ai Hospital from July 2006 to March 2016 were collected and divided into two groups based on Hughes functional grading scale（HFGS）,the RF group（HFGS=5points）and non-RF group（HFGS=4points）at the nadir of illness,and the good recovery group（HFGS3points）and the bad recovery group（HFGS≥3points）3months after onset of the illness.Characteristics of each group were analyzed in Logistic regression model in order to find out the independent risk factors of GBS with RF and the short-term（3months）and long-term（1year）prognosis of GBS.Results In all the 62 patients studied,25 were GBS with RF.Peak time less than one week（OR=3.957,95%CI：1.141-13.724,P=0.030,2.957 times as much as other patients）,autonomic nervous dysfunction（OR=4.259,95%CI：1.306-13.890,P=0.016,3.259 times as much as other patients）were independent risk factors for GBS with RF.There was statistically significant difference of cranial nerve involvement as the initial symptom between the RF group and non RF group（P〈0.05）,but it was not the independent risk factor for severe GBS with RF.38.7% patients could walk independently 3 months after onset of the illness,while 74.4% patients could walk independently after 1year.There was 6-22 fold increase of the risk for bad recovery in axonal GBS than that in demyelinating type from3 months to 1year after onset of the illness.And the risk of bad recovery decreased 73%-77% in patients with sensory disturbances 3months to 6months after onset of the illness.But the influence of sensory disturbances torecovery declined 1year after onset.There was a mild increased risk of bad recovery in aged patients at 1year.Conclusions Rapid progression of disease and combining with autonomic nervous dysfunction are suggested as predictors of RF in GBS.There are 3/4severe GBS who could walk independently after 1year of illness,and prognosis is relatively poor in axonal damaged,aged patients in long time.