A波为儿童吉兰-巴雷综合征脱髓鞘标志并与短期预后相关

A wave is a marker in demyelination subtype in children′s Guillain-Barresyndrome and it correlates with short-term prognosis

目的探讨A波在吉兰-巴雷综合征(GBS)神经电生理分型中的作用,及其在评估急性炎症性脱髓鞘型多发性神经病(AIDP)临床严重程度与短期预后中的作用。方法纳入2014年3月至2017年3月华中科技大学同济医学院附属武汉儿童医院神经内科诊断为GBS的56例患儿,根据神经电生理结果将GBS分为AIDP组(40例)和轴突型GBS组(16例)。根据神经电生理检查中A波是否存在,将患儿分为伴有A波GBS组(18例)和A波缺失GBS组(38例),回顾性分析2组病例的年龄、性别、前驱感染病史,颅神经受累,自主神经受累及神经电生理分型、传导阻滞情况。为判断A波与病情严重程度、预后间的关系,AIDP组患儿根据A波的存在分为伴有A波AIDP组(18例)和A波缺失AIDP组(22例),比较2组年龄、性别、临床严重程度、短期预后及传导阻滞情况。结果伴有A波GBS组与A波缺失GBS组比较,年龄、性别、前驱感染病史,颅神经受累,自主神经受累比较差异均无统计学意义(均P>0.05)。传导阻滞更多见于伴有A波GBS组(10例比2例,χ^2=18.021,P=0.000)。18例A波均见于AIDP病例中,AIDP组A波出现率为45%(18/40例)。轴突型GBS中无A波出现。伴有A波AIDP组与A波缺失AIDP组比较,伴有A波AIDP组临床严重程度更重[(3.39±1.09)分比(2.50±1.01)分,t=2.667,P=0.011],短期预后更差[(2.06±0.64)分比(1.55±0.60)分,t=2.607,P=0.013],传导阻滞更多见(10例比2例,χ^2=9.924,P=0.002)。结论A波为GBS脱髓鞘指标,仅存在于AIDP中,伴有A波的AIDP患儿无力症状更严重,短期预后更差。

Objective To explore the A wave value in neuroelectrophysiological subtype of Guillain-Barrésyndrome(GBS)and the clinical severity and short-term prognosis of acute inflammatory demyelinating polyradiculoneuropathy(AIDP).Methods From March 2014 to March 2017,a total of 56 children with GBS at Department of Neurology of Wuhan Children′s Hospital Affiliated to Tongji Medical College,Huazhong University of Science&Technology were enrolled.The patients were divided into AIDP subtype(40 cases)and axonal GBS subtype(16 cases)according to the results of electrophysiological examination.According to whether there was existence of A wave or not,the GBS children were divided into 2 groups.The first group was the A wave in GBS group(18 cases),and the second group was non-A wave in GBS group(38 cases).In order to explore classification value for GBS with A wave,clinical data including age,gender,history of prodromal infection,cranial nerve dysfunction,autonomic nerve involvement and conduction blocks were analyzed.To explore A wave value in clinical severity and short-term prognosis of AIDP,the age,gender,clinical severity,conduction blocks,short-term prognosis of the 2 groups were analyzed in A wave with AIDP(18 cases)and non-A wave with AIDP(22 cases).Results Compared with non-A wave GBS patients,A wave GBS patients had more conduction blocks(10 cases vs.2 cases,χ^2=18.021,P=0.000).Age,sex,precedent infections,cranial nerve involvement,autonomic nerve involvement were not significantly statistically different(all P>0.05).A wave was only seen in AIDP subtype(18 cases),and the percentage of A wave in AIDP was 45%(18/40 cases).There was no A wave in axonal GBS.Compared with non-A wave in AIDP,A wave in AIDP patients had more conduction blocks(10 cases vs.2 cases,χ^2=9.924,P=0.002),poorer clinical motor function[(3.39±1.09)scores vs.(2.50±1.01)scores,t=2.667,P=0.011]and short-term prognosis[(2.06±0.64)scores vs.(1.55±0.60)scores,t=2.607,P=0.013].Conclusions A wave is correlated with demyelination subtype in children′s Guillain-Barrésyndrome and poor short-term prognosis in AIDP.