复发型吉兰—巴雷综合征临床特征及其复发预测因子分析

Clinical characteristics and prognostic biomarker of recurrent Guillain-Barrésyndrome

目的分析复发型吉兰—巴雷综合征(rGBS)患者的临床特征及炎性因子与GBS复发的相关性。方法选取2015年1月—2020年6月徐州医科大学附属医院神经内科收治GBS患者183例,根据其是否复发分为复发组(n=11)和未复发组(n=172),比较2组患者临床特征、血清和脑脊液炎性因子。Logistic回归分析GBS复发的独立危险因素,ROC曲线分析炎性标志物对GBC复发的预测价值。结果 GBS复发率为6.0%(11/183)。与未复发组比较,复发组首发年龄较低,症状达峰时间较短,肢体无力和自主神经功能障碍比例、疾病高峰期Hughes评分较低,脱髓鞘型比例较高,差异均有统计学意义(t/χ~2/P=2.488/0.028、2.853/0.021、4.329/0.037、3.908/0.047、2.320/0.029、8.440/0.015);而性别、感觉障碍、颅神经麻痹、机械通气比例,差异无统计学意义(P>0.05)。与未复发组比较,复发组血清NLR、IL-8升高,LY和IL-13降低(t/Z/P=2.633/0.008、2.019/0.045、1.812/0.035、2.573/0.011)。多因素Logistic回归分析表明,高NLR为GBS复发的独立危险因素[OR(95%CI)=1.363 (1.027~1.808)],高IL-13为其保护因素[OR(95%CI)=0.867(0.780~0.963)]。NLR联合IL-13预测GBS复发ROC曲线下面积为0.818(95%CI 0.684~0.942),敏感度为73.3%,特异度为82.5%,约登指数为0.56。结论对于首次发作的GBS患者,高NLR、低IL-13者复发风险高;NLR和IL-13可作为预测复发的指标,二者联合预测价值更高。

Objective To analyze the clinical characteristics of recurrent Guillain-Barrésyndrome(rGBS)and the relationship between inflammatory factors with rGBS in order to guide clinical diagnosis and treatment.Methods A study was conducted on 183 patients who developed Guillain-Barrésyndrome between January 2015 to June 2020 in the Affiliated Hospital of Xuzhou Medical University;Patients were divided into recurrent group and non-recurrent group based on the number of episodes.Then the sex,age of onset,clinical manifestations,the level of inflammatory factors in serum and cerebrospinal fluid of all enrolled patients were summarized.Results The estimated crude morbidity of rGBS was 6.0%(11/183).Compared with non-recurrent group,recurrent group had younger onset,shorter interval between the initial manifestations to peak,lower proportion of symmetrical weakness and autonomic dysfunction,lower Hughes score in the peak period and higher proportion of demyelinating type(t/χ2/P=2.488/0.028,2.853/0.021,4.329/0.037,3.908/0.047,2.320/0.029,8.440/0.015).But there was no statistically significant difference in sex,sensory disturbances,cranial nerve palsy,mechanical ventilation between the two groups(P>0.05).Compared with non-recurrent group,NLR and the level of IL-8 in recurrent group was higher,LY and the level of IL-13 was lower(t/Z/P=2.633/0.008,2.019/0.045,1.812/0.035,2.573/0.011);Logistic regression analysis showed high NLR was independent risk factors predicting GBS recurrence[OR(95%CI)=1.363(1.027-1.808)].While high IL-13 level was protective factors of GBS recurrence[OR(95%CI)=0.867(0.780-0.963)].The area under ROC curve for the NLR combining IL-13 to predict GBS recurrence was 0.818(95%CI:0.684-0.942),with a sensitivity of 73.3%,a specificity of 82.5%and Youden index of 0.56.Conclusion The higher risk of recurrence may be considered in GBS patients with high NLR and low IL-13 level.NLR and IL-13 may be used as a marker to predict GBS recurrence,which combined is more reliable for predicting GBS recurrence.