基于单中心的重症吉兰-巴雷综合征预测因素分析

Analysis of predictors of severe Gullain-Barré syndrome based on single center

目的:基于单中心资料探讨重症吉兰-巴雷综合征(GBS)的预测因素,以指导GBS早期管理。方法:收集1998年5月至2017年12月在徐州医科大学附属医院神经内科住院的245例GBS患者的临床资料。根据GBS分级标准,将患者分为轻型组和重型组,比较两组患者性别、年龄、前驱感染史、神经系统症状及合并症等情况。将单因素分析中差异有统计学意义的因素纳入多因素logistic回归分析,分析预测GBS发展为重型的因素。结果:245例GBS患者中,轻型组81例(33.1%),重型组164例(66.9%)。logistic回归分析显示,年龄≥40岁(OR=2.729)、上肢首发(OR=4.372)、延髓麻痹(OR=6.468)、自主神经功能障碍(OR=5.166)、腱反射减弱(OR=5.213)、有合并症(OR=3.507)为重型GBS的预测因素(P<0.05)。当患者有0个预测因素时,重型GBS发生率为0;当有1～3个预测因素时,重型GBS发生率分别为49.2%、61.4%、93.5%;当有4～6个预测因素时,重型GBS发生率为100%。结论:年龄≥40岁、延髓麻痹、上肢首发、自主神经功能障碍、腱反射减弱、有合并症是重症GBS的预测因素;随着预测因素数量的增多,GBS加重的可能性增大。

Objective:To investigate the predictors of severe Gullain-Barrésyndrome(GBS)based on single center.Methods:A total of 245 cases of inpatients with GBS between May 1998 and December 2017 were selected at the Department of Neurology,Affiliated Hospital of Xuzhou Medical University.The inpatients were divided into two groups based on Hughes scale,and the gender,age,residence attribute,prodrome infection history,neurological symptoms,and complications were compared between the two groups.The factors with statistically significant differences in the univariate analysis were included into the multivariate analysis,and the predictors of severe GBS were analyzed.Results:Among the 245 patients,81 cases(33.1%)in the mild group and 164 cases(66.9%)in the severe group.Logistic regression analysis showed that age≥40 years old(OR=2.729),initial symptom with upper limb(OR=4.372),bulbar paralysis(OR=6.468),autonomic nervous dysfunction(OR=5.166),degraded tendon reflex(OR=5.213)and complications(OR=3.507)were predictors of severe GBS.There was no chance to be severe GBS when patients had no predictor.The chance to be severe GBS was 49.2%,61.4%,and 93.5%when patients had 1,2,3 predictors,respectively.And the chance to be severe GBS was 100%when patients had 4 to 6 predictors.Conclusions:The age≥40 years old,initial symptom with upper limb,bulbar paralysis,autonomic nervous dysfunction,degraded tendon reflex,and complications were predictors of severe GBS.As the number of prediction factors increases,the possibility of GBS aggravating increases.