少见变异型吉兰-巴雷综合征临床特点分析

Analysis of clinical characteristics of rare variant Guillain-Barre syndrome

目的介绍变异型吉兰-巴雷综合征(GBS)的一些少见临床特征并探讨其可能的发病机制,为早期诊断提供帮助。方法回顾性分析深圳市人民医院2017年10月至2018年6月收治的4例变异型GBS患者的临床资料,对其临床表现、实验室资料及治疗转归进行总结。结果4例患者均为肢体无力起病,但均存在与典型GBS不一致体征,各具特点。1例为非对称性肢体瘫痪;1例以严重持续背痛伴截瘫起病;1例伴有明显头痛及脑膜刺激征;1例以截瘫伴感觉平面、病理征阳性起病。脑脊液检查4例均存在蛋白-细胞分离。肌电图均符合周围神经源性损害。头部MRI+脊髓MRI未见新发病变。4例经过丙种球蛋白及激素治疗后均明显好转。结论变异型GBS少见,临床症状广泛,不典型的患者需要进一步完善相关的检查确诊,以免延误病情。

Objective To introduce some rare clinical features of the variant Guillain-barre syndrome(GBS)and to explore its possible pathogenesis for the early diagnosis.Methods The clinical data,laboratory data and treatment outcomes of four patients,who admitted to Shenzhen People′s Hospital from October 2017 to June 2018 and diagnosed with variant GBS were analyzed and summarized.Results All the four patients presented limb weakness as a first manifestation.However,they all had clinical features that were inconsistent with typical GBS,and the clinical features were shown differently in each patient.One patient showed asymmetrical limb paralysis.The first manifestation of one patient was severe and persistent back pain accompanied by paraplegia.One patient was accompanied by obvious headache and positive meningeal irritation.One patients had the plane of sensory obstacles,paraplegia,and positive pathological sign.Cerebrospinal fluid examination showed protein cell dissociation in four patients.Electromyogram was consistent with peripheral neurogenic damage.Magnetic resonance imaging(MRI)of the brain and the spinal cord showed no obvious abnormalities.The four patients with obvious improvement in symptoms were treated with gamma globulin and glucocorticoid.Conclusions Variant GBS is rare and clinical symptoms are various.Patients with atypical clinical symptoms should still be diagnosed by relevant auxiliary examinations to avoid delayed illness.