吉兰-巴雷综合征患者远期预后不良的相关因素分析

Risk Factors for the Long-term Prognosis of Patients with Guillain-Barré Syndrome

目的:探讨吉兰-巴雷综合征(Guillain-Barre syndrome,GBS)患者的各项临床参数对远期预后的影响,筛选可导致远期预后不良的危险因素。方法:收集2014年1月-2016年6月在唐都医院医治的84例GBS患者的临床资料。依据发病后1年的Hughes评分将患者分成预后良好组(≤2分)和预后不良组(≥3分)。分析性别、起病年龄、高峰期病情等级评分、自主神经功能障碍、颅神经受累、电生理分型、神经传导阻滞、空腹血糖以及血清白蛋白水平等对GBS患者远期预后的影响。结果:本研究共纳入84例GBS患者,其中预后良好组69例(82.1%),预后不良组15例(17.9%)。预后不良组在起病年龄≥50岁(80%vs 52.2%)、需机械通气辅助呼吸(33.3%vs 2.9%)、存在尿便障碍(33.3%vs 2.9%)、发病高峰时Hughes评分≥4分(100%vs 62.3%)、入院时存在低白蛋白血症(53.3%vs 13%)、延髓麻痹(46.7%vs 18.8%)、接受糖皮质激素治疗(40%vs 8.7%)等方面的患者比率显著高于预后良好组(P均<0.05)。多因素Logistic回归分析显示起病年龄≥50岁(P=0.040,OR=9.020)、存在尿便功能障碍(P=0.023,OR=10.643)、入院时低白蛋白血症(P=0.003,OR=9.927)、接受糖皮质激素治疗(P=0.035,OR=8.576)是远期预后不良的高危因素。结论:晚发患者、尿便功能障碍、入院时低白蛋白血症、应用糖皮质激素是GBS远期预后不良的危险因素,临床实践中要积极加强患者营养并避免使用不恰当的免疫抑制剂治疗。

Objective： To explore the risk factors of poor long-term outcome for patients with Guillain-Barré syndrome（GBS）.Methods： All data of 84 patients with GBS from January 2014 to June 2016 in Tangdu hospital were collected. According to the Hughes score at 1 year after onset, the patients were divided into the good outcome group（≤2） and the poor outcome group（≥3）. The effects of gender, onset age, the Hughes score at nadir, autonomic dysfunction, cranial nerve involvements, electrophysiological classification,nerve conduction block, fasting blood glucose and serum albumin level on long-term outcome were analyzed. Results： A total of 84 patients with GBS were eventually included, including 69 patients with good outcome（82.1%） and 15 patients with poor outcome（17.9%）. Compared with good the outcome group, there was a higher percentage of patients with onset age ≥ 50 years（80% vs 52.2%）,mechanical ventilation（33.3% vs 2.9%）, bowel/bladder dysfunction（33.3% vs 2.9%）, the Hughes score ≥ 4 at nadir（100% vs 62.3%）,hypoalbuminemia（53.3% vs 13%）, bulbar paralysis（46.7% vs 18.8%）, use of glucocorticoids（40% vs 8.7%） in poor outcome group（all Ps 0.05）. Multivariate logistic regression analysis showed that onset age ≥ 50 years（P = 0.040, OR = 9.020）, bowel/bladder dysfunction（P = 0.023, OR = 10.643）, hypoalbuminemia on admission（P = 0.003, OR = 9.927）, and use of glucocorticoids（P = 0.035,OR = 8.576） were risk factors of poor long-term outcome in GBS patients. Conclusion： Later onset age, bowel/bladder dysfunction,hypoalbuminemia, and application of glucocorticoids are risk factors for poor long-term prognosis in patients with GBS, which suggests the necessity for strengthening nutrition support and avoiding inappropriate immunosuppressant therapy in clinical practice.