空腹血糖水平与吉兰巴雷综合征短期预后的关系

Relationship between fasting plasma glucose level and short-term prognosis of Guillain-Barrésyndrome

目的:探究针对空腹血糖(fasting plasma glucose,FPG)水平异常与吉兰-巴雷综合征(Guillain-Barrésyndrome,GBS)的相关性,分析FPG升高是否为GBS病人短期预后不良的独立危险因素。方法:回顾性分析146例GBS病人临床资料,根据FPG水平分为正常FPG组(n=90)和高FPG组(n=56)。比较2组性别、年龄、神经系统体征、有无前驱感染史、是否合并颅神经麻痹、感觉障碍、自主神经受累、呼吸费力、MRC总分和休斯功能分级量表(Hughes functional grading scale,HFGS)评分等基本资料。分析2组脑脊液蛋白水平、葡萄糖水平、有无蛋白细胞分离、潘氏试验结果等生化资料以及神经电生理资料差异。根据病人出院时HFGS评分分为轻型组(HFGS≤3分)和重型组(HFGS>3分),分析FPG水平与GBS短期预后的关系。结果:2组病人年龄、性别、前驱感染史、感觉障碍、腱反射减弱或消失、脑膜刺激征、神经电生理分型及脑脊液蛋白水平、蛋白细胞分离和潘氏试验结果差异均无统计学意义(P>0.05)。正常FPG组病人手术外伤史发生率、颅神经受累率、合并自主神经功能障碍率、呼吸困难发生率、辅助通气率、巴氏征发生率、出院时HFGS评分为5和6、脑脊液葡萄糖浓度均低于高FPG组(P<0.05~P<0.01),高峰时MRC评分明显低于高FPG组(P<0.01)。单因素分析显示,年龄大、颅神经受累、自主神经功能障碍、脑脊液蛋白含量高、FPG水平高以及血C反应蛋白水平高均是GBS病人短期预后不良的危险因素(P<0.05~P<0.01),脑脊液细胞数与病人短期预后无明显相关性(P>0.05)。多因素logistic回归分析显示,年龄大、颅神经受累、脑脊液蛋白含量高和FPG水平高均为GBS病人短期预后不良的独立危险因素(P<0.05~P<0.01)。结论:FPG升高的GBS病人病情更重、更易出现颅神经受累、自主神经功能障碍、呼吸困难和依赖机械通气,短期预后更差。FPG升高是GBS病人短期预后不良的独立危险因素。

Objective:To investigate the correlation between abnormal fasting plasma glucose(FPG)level and Guillain-Barrésyndrome(GBS),and to analyze whether elevated FPG level being an independent risk factor for poor short-term prognosis in patients with GBS.Methods:The clinical data of 146 patients with GBS were retrospectively analyzed.According to the FPG level,the patients were divided into normal FPG group(n=90)and high FPG group(n=56).Gender,age,neurological signs,history of precursor infection,cranial nerve palsy,sensory disturbance,autonomic nerve involvement,difficulty breathing,total score of MRC and Hughes functional grading scale(HFGS)score were compared between the two groups.The differences of protein level,glucose level,protein-cell separation,Pandy test results in cerebrospinal fluid and electrophysiological data between the two groups were analyzed.According to the HFGS score at discharge,the patients were divided into mild group(HFGS score≤3 points)and severe group(HFGS score>3 points).The relationship between FPG level and short-term prognosis of GBS was analyzed.Results:There were no significant differences in age,sex,history of precursor infection,sensory disturbance,decrease or absence of tendon reflex,meningeal irritation sign,neuroelectrophysiological classification and protein level,protein-cell separation,Pandy test results in cerebrospinal fluid between the two groups(P>0.05).The incidence of surgical trauma history,cranial nerve involvement,combination of autonomic nerve dysfunction,difficulty breathing,assisted-ventilation,Babinski sign,HFGS score of 5 and 6 at discharge,and glucose concentration in cerebrospinal fluid in normal FPG group were higher than those in high FPG group(P<0.05 to P<0.01),and MRC score at nadir was significantly lower than that in high FPG group(P<0.01).Univariate analysis showed that age,cranial nerve involvement,autonomic nerve dysfunction,and high protein content,high FPG level,high serum C reactive protein level in cerebrospinal fluid were risk factors of poor short-term prognosis in GBS patients(P<0.05 to P<0.01);the cell number in cerebrospinal fluid was not significantly correlated with short-term prognosis in GBS patients(P>0.05).Multivariate logistic regression analysis showed that high age,cranial nerve involvement,and high protein level,high FPG level in cerebrospinal fluid were independent risk factors for poor short-term prognosis in GBS patients(P<0.05 to P<0.01).Conclusions:GBS patients with elevated FPG level are more severe,more likely to have cranial nerve involvement,autonomic nerve dysfunction,difficulty breathing,dependence on mechanical ventilation,and worse short-term prognosis.Elevated FPG level is an independent risk factor for poor short-term prognosis in patients with GBS.