中国南方吉兰-巴雷综合征的流行病学和临床特点城乡差异分析

Analysis of differences in epidemiology and clinical features of Guillain-Barre syndrome between rural and urban areas of southern China

目的中国南方农村与城市吉兰-巴雷综合征(GBS)流行病学及临床特点的差异分析.方法收集2013年1月1日至2016年9月30日期间,中国南方13个省/市共31家医院的759例GBS,提取相关临床资料进行分析对比.结果农村与城市GBS以男性多发,发病中位年龄分别为49岁和48岁;农村与城市GBS在冬春季高发,农村季节间差异(P=0.003)比城市季节间(P=0.035)更显著,但两地区冬春季发病差异无统计学意义(P=0.738);70.37%农村与73.69%城市患者前驱事件为呼吸道感染;农村和城市经典型GBS达峰的中位时间均为7 d,二者入院、达峰和出院时Hughes GBS残障评分(H-GBS-DS)分别为(2.95±1.10比2.84±1.15)分,(3.25±1.11比3.14±1.21)分,(2.02±1.24比2.00±1.31)分;84.34%农村和84.62%城市患者脑脊液可见蛋白-细胞分离;8.65%农村和10.94%城市患者住院期间行机械通气;脱髓鞘性GBS为主要临床亚型,农村占53.29%,城市占48.77%.结论中国南方农村GBS以男性多发,呼吸道感染为主要诱因,最常见的临床亚型为脱髓鞘性,与城市之间无差异;农村及城市GBS于冬春季高发;农村及城市GBS在起病年龄、性别构成、季节分布、病程进展、亚型分布、脑脊液检查方面无显著差异.

Objective To explore the differences in epidemiology and clinical features of Guillain-Barrésyndrome(GBS)between rural and urban areas of southern China.Methods The clinical data of 759 hospitalized GBS patients from 31 hospitals of 13 provinces/cities in southern China,between January 1st,2013 and September 30th,2016,were collected and analyzed retrospectively.Results The risk of GBS was higher for males than females in rural and urban areas and the median age was 49 and 48 years,respectively.Seasonal clustering in winter and spring was noted in both rural and urban areas,and the seasonal trend was more markedly in rural areas,but the differences showed no statistical significance.There were 70.37% of patients in rural areas and 73.69% in urban areas who had antecedent respiratory infection.The median time from onset to nadir was 7 days,and Hughes Disability Scale at admission,nadir and discharge were(2.95±1.10 vs 2.84±1.15),(3.25±1.11 vs 3.14±1.21),(2.02±1.24 vs 2.00±1.31)in rural and urban areas respectively.Albuminocytologic dissociation was present in 84.34% of patients in rural areas and 84.62% of cases in urban areas.There were 8.65% and 10.94% of cases in rural and urban areas who required mechanical ventilation during hospitalization,respectively.Demyelinating GBS accounted for 53.29% and 48.77%,respectively,in patients with findings of nerve conduction studies available in rural and urban areas.Conclusions GBS in rural areas of southern China showed male predominance and a peak of spring and winter occurrence,with respiratory infection as the predominated preceding events and demyelinating GBS being main clinical subtype.Winter and spring showed a higher incidence of GBS in rural and urban areas.There were no significant differences of sex,age,preceding events,season trend,progression of disease,clinical subtypes and cerebrospinal fluid investigations in GBS patients between rural and urban areas.