血浆置换术治疗儿童吉兰-巴雷综合征的疗效观察

Observation on efficacy of plasma exchange on children with Guillain-Barre syndrome

目的通过回顾性研究比较血浆置换术(PE)及传统疗法治疗儿童吉兰-巴雷综合征(GBS)的临床疗效。方法 46例GBS患儿,根据治疗方法不同分为PE组(18例)、免疫球蛋白组(21例)、激素组(7例)。所有患儿均给予常规内科治疗,在此基础上, PE组患儿接受淋巴血浆置换术(LPE)治疗,免疫球蛋白组患儿采用丙种球蛋白静脉注射治疗,激素组采用大剂量激素冲击治疗。观察比较三组患儿的临床疗效、治疗前后肌力评分、肌力改善时间、住院时间、使用呼吸机情况、脱机时间以及不同治疗时机的疗效。结果 PE组、免疫球蛋白组患儿的总有效率分别为88.9%、85.7%,均明显高于激素组的28.6%,差异均有统计学意义(χ~2=9.095、8.400, P<0.05)。PE组与免疫球蛋白组的总有效率比较差异无统计学意义(χ~2=0.087, P>0.05)。经治疗后, PE组患儿的肌力评分高于免疫球蛋白组及激素组,差异均有统计学意义(P<0.05)。PE组患儿的肌力改善时间、住院时间均明显短于免疫球蛋白组、激素组,差异均有统计学意义(P<0.05)。PE组患儿脱机时间明显短于免疫球蛋白组、激素组,差异均有统计学意义(P<0.05)。PE组、免疫球蛋白组患儿病程≤5 d的总有效率明显高于激素组,差异均有统计学意义(P<0.05);但两组间比较差异无统计学意义(P>0.05)。结论 PE治疗儿童GBS的临床疗效优于免疫球蛋白及激素治疗。早期积极给予PE或免疫球蛋白治疗可明显提高疗效。

Objective To retrospectively study the clinical efficacy of plasma exchange(PE) and traditional therapy in the treatment of Guillain-Barre syndrome(GBS) in children. Methods A total of 46 GBS children were divided by different treatment methods into PE group(18 cases), immunoglobulin group(21 cases) and hormone group(7 cases). All patients were treated with conventional medical treatment. On this basis, PE group received lymphoplasma replacement(LPE), immunoglobulin group received intravenous injection of gamma globulin, and the hormone group received high-dose hormonal shock therapy. Observation and comparison were made on clinical efficacy, muscle strength score before and after treatment, muscle strength improvement time, hospitalization time, use of ventilator, off-line time and and efficacy of different treatment timings in three groups. Results PE group and immunoglobulin group had total effective rate respectively as 88.9% and 85.7%, which were all obviously higher than 28.6% in hormone group, and the difference was statistically significant(χ^2=9.095, 8.400, P<0.05). But PE group and immunoglobulin group had no statistically significant differencein total effective rate(χ^2=0.087, P>0.05). After treatment, PE group had higher muscle strength score than immunoglobulin group and hormone group, and their difference was statistically significant(P<0.05). PE group had obviously shorter muscle strength improvement time and hospitalization time than immunoglobulin group and hormone group, and their difference was statistically significant(P<0.05). PE group had obviously shorter off-line time than immunoglobulin group and hormone group, and their difference was statistically significant(P<0.05). PE group and immunoglobulin group had obviously higher total effective rate of ≤5 d course of disease than hormone group, and the difference was statistically significant(P<0.05), but there was no statistically significant difference between two groups(P>0.05). Conclusion PE is superior to immunoglobulin and hormone in the treatment of GBS in children. Early active treatment with PE or immunoglobulin can significantly improve the curative effect.