吉兰-巴雷综合征的临床分型及预后研究

Clinical classification and prognosis of Guillain-Barre syndrome

目的分析吉兰-巴雷综合征的临床分型和预后,掌握该病的各亚型临床特点、预后及影响因素。方法选取150例吉兰-巴雷患者,根据其电生理表现、临床表现分为Bickerstaff脑干脑炎叠加吉兰-巴雷综合征(BBE-GBS)组、脑神经型(CNV)组、Miller-Fisher综合征(MFS)组、急性运动轴索性神经病(AMAN)组、急性炎症性脱髓鞘性多发神经病(AIDP)组。分析各型患者的GBS特点,采用多因素Logistic回归分析和方差分析对患者预后的影响因素和预后情况进行分析。结果各组达峰值时HFGS评分两两比较结果显示,AMAN和AIDP组有显著差异(P<0.05),AIDP与BBE-GBS组差异无统计学意义(P>0.05),AMAN与BBE-GBS组差异无统计学意义(P>0.05)。各型GBS达峰值时HFGS均值情况显示,AMAN与BBEGBS组病情较AIDP组严重,AMAN与AIDP组差异有统计学意义(P<0.05);AMAN与AIDP组3个月、6个月的预后差异有统计学意义(P<0.05),AIDP与BBE-GBS组在3个月、6个月的预后差异有统计学意义(P<0.05),AMAN与BBE-GBS组3个月、6个月预后差异无统计学意义(P>0.05)。对预后的影响因素进行分析,结果显示自主神经功能障碍、真性球麻痹、达峰时HFGS≥3是GBS预后的主要影响因素。结论 AIDP为中国GBS的主要亚型,AMAN与BBE-GBS组3个月、6个月的预后均不如AIDP组,CNV与MFS组预后较好。GBS患者分型为重型、真性球麻痹、自主神经功能障碍是GBS预后的主要影响因素。

Objective To analyze the clinical classification and prognosis of Guillain-Barre syndrome and to understand the clinical features, prognosis and influencing factors of subtypes of the disease. Methods A total of 150 Guillain-Barre patients were enrolled in this study. According to their electrophysiological manifestations, the clinical manifestations were divided into Bickerstaff brainstem encephalitis superposition Gillan-Barre （BBE-GBS）, neurological （CNV）, Miller-Fisher syndrome （MFS）, acute motor axonal neuropathy （AMAN）, acute inflammatory demyelinating polyneuropathy （AIDP）. The characteristics of GBS were analyzed and the patients were followed up. Multivariate Logistic regression analysis and variance analysis were used to analyze the prognostic factors and prognosis of patients. Results There was significant difference between AMAN and AIDP group （P 〈 0. 05 ）. There was no significant difference between AIDP and BBE-GBS group （P 〉 0.05）. There was no significant difference between the AMAN and BBE-GBS group （P 〉 0. 05 ）. The severity of AMAN and BBE-GBS group was more severe than that of AIDP group （P 〈 0.05 ）. The difference of AMAN and AIDP group at 3 and 6 months was significant （ P 〈 0.05 ）. The difference of AIDP and BBE-GBS group at 3 and 6 months was significant （P 〈 0.05 ）, and there were no significant differences in the prognosis of 3 months and 6 months between AMAN and BBE-GBS group （P 〉 0.05）. Autonomic dysfunction, true ball paralysis, peak HFGS ≥ 3 were the main prognostic factors of GBS . Conclusion AIDP is the main subtype of GBS . The prognosis of AMAN and BBE-GBS group is worse than that of AIDP group and CNV and MFS group. Severe type of disease, true ball paralysis and autonomic dysfunction are the main prognostic factors of GBS.