吉兰-巴雷综合征病情严重程度的可能预测指标研究

The study of predictors for severity of Guillain-Barré syndrome

目的通过分析吉兰-巴雷综合征(Guillain-Barrésyndrome,GBS)患者的临床特点、神经电生理、脑脊液特点,比较不同严重程度患者的疾病特点,研究GBS病情严重程度的可能预测因素。方法选择2014-09-01—2017-08-31期间入住徐州医科大学附属医院的首次发病的急性期GBS患者110例,收集所有患者的临床资料,血液生化、脑脊液检查、肌电图结果等资料。根据患者发病高峰时GBS残疾评分评价患者病情严重程度,将患者分为重型组和轻型组,将两组间差异有统计学意义的因素及相关因素行Logistic多因素回归分析,并对所获得的独立预测指标绘制受试者工作特征曲线(receiver operating curve,ROC)进行分析。结果两组间比较,年龄、血清白蛋白、血清球蛋白及脑脊液蛋白差异有统计学意义(均P<0.05)。将上述因素以及前驱感染、合并自主神经功能障碍、肌电图异常等可能影响病情严重程度的指标一起纳入模型,行多因素Logistic回归分析,结果显示血清白蛋白[OR(95%CI)为0.863(0.756~0.986),P=0.03]、脑脊液蛋白[OR(95%CI)为4.648(1.555~13.900),P=0.006]、年龄[OR(95%CI)为1.063(1.028~1.100),P<0.001]为独立预测因素。分别以血清白蛋白、脑脊液蛋白、年龄为检验变量,病情进展为重型为状态变量,做预测指标的ROC曲线,三者曲线下面积(area under curve,AUC)分别为:白蛋白AUC(95%CI)为0.773(0.683~0.848),脑脊液蛋白AUC(95%CI)为0.736(0.643~0.815),年龄AUC(95%CI)为0.708(0.614~0.791)。结论血清白蛋白水平、年龄、脑脊液蛋白水平是GBS患者病情严重程度的独立预测因素,年龄越高、血清白蛋白水平越低、脑脊液蛋白水平越高,病情越重。

Objective To analyze the clinical,electrophysiological,cerebrospinal fluid＇s characteristics and severity of Guillain-Barrésyndrome（GBS）,and explore the predictors for the severity of GBS.MethodsPatients were admitted to the affiliated hospital of Xuzhou medical university from September 2014 to September2017 and fulfilled the diagnostic criteria from the 2010 Chinese GBS guidelines.We retrospectively collected and assessed the clinical characteristics,electrophysiological tests,and cerebrospinal fluid＇s data.We used the GBS disability scale to evaluate the clinical status of patients.Clinical characteristics,electrophysiological tests and cerebrospinal fluid＇s data of GBS were analyzed in multivariable logistic model in order to find out the related factors of the severity of GBS.Then we performed the ROC for risk factors for severity of GBS.Results The study includes 110 patients.The mild group included 42 patients and the severe group includes 68 patients,whose mean age was 47.45±16.12 years old（range 13 to 78 years）.An upper respiratory tract infection or diarrhea was common as the prodromal infection.There were 13 patients who experienced mechanical ventilation.Autonomic dysfunction was found in 35 patients.Cranial nerves were involved in 39 patients.The mean time of hospitalization was 15.05±6.7 days.All patients underwent blood biochemical examination.The majority of patients underwent lumbar puncture（99 cases）and took cerebrospinal fluid biochemical examination and immunoglobulin examination.90 patients undewent the electrophysiological tests,including 35 cases of axonal impairment and 18 cases of demyelination.Age,albumal,globulin,prodromal infection,autonomic dysfunction,cranial nerve involvement might be related to severity of GBS,and were analyzed by the logistic regression analysis.We found that age（χ2=-4.010,P=0.001）,albumin（t=5.502,P〈0.001）,globulin（t=-3.091,P = 0.003）had statistically significant differences between the two groups. Adding in the electrophysiological tests,and the cerebrospinal fluid＇s data into multivariate analysis,we found that albumin（P=0.03,OR=0.863,OR95% CI：0.756-0.986）,cerebrospinal fluid protein（P=0.006,OR=4.648,OR95% CI：1.555-13.900）,and age（P〈0.001,OR=1.063,OR 95% CI：1.028-1.100）,were independently associated with severe GBS.With albumin as the test variable and the severity of GBS as state variable,we described the ROC of albumin.The AUC was 0.773.Conclusions Albumin and age may be the early predictors for the severity of GBS.Albumin,age,and cerebrospinal fluid protein were independently associated with severe GBS.Albumin levels play an important role in predicting the severity of GBS.