中国南方GBS合并低钠血症的临床特征及预后影响因素的多中心回顾性研究

Clinical characteristics of Guillain-Barrésyndrome combined with hyponatremia in Southern China and its risk factors for prognosis:a multi-center retrospective analysis

目的探讨中国南方吉兰-巴雷综合征(GBS)合并低钠血症患者的临床特征、高危因素及预后影响因素。方法回顾性收集中国南方(淮河以南)6个省(市)共18家三级甲等医院神经内科自2013年1月至2016年9月收治的570例GBS患者的临床资料,按照英国医学研究理事会(MRC)的等级标准评定患者病情严重程度,根据血钠水平将患者分为低钠血症组和血钠正常组。出院时参照Hughes GBS残障评分(H-GBS-DS)评估GBS患者的预后。比较轻、中、重度GBS患者的低钠血症发生率。多因素Logistic回归分析确定GBS患者合并低钠血症的危险因素。比较合并低钠血症的患者中预后良好和预后不良患者的临床资料,多因素Logistic回归分析确定GBS合并低钠血症患者预后不良的危险因素。结果(1)570例患者中轻、中、重度GBS患者分别为354、94和122例;合并低钠血症134例,血钠正常436例。轻、中、重度GBS组患者的低钠血症发生率依次增加,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:面瘫(OR=1.979,95%CI:1.172~3.342,P=0.011)、呼吸肌麻痹(OR=3.218,95%CI:1.611~6.428,P=0.001)、继发肺部感染(OR=4.822,95%CI:2.835~8.201,P=0.000)、重度GBS(OR=2.611,95%CI:1.444~4.721,P=0.001)和住院时间(OR=1.029,95%CI:1.009~1.050,P=0.004)是GBS患者合并低钠血症的危险因素。(2)合并低钠血症的134例患者中,预后不良80例,预后良好54例。与预后良好组比较,预后不良组患者中眼外肌麻痹者所占比例较低,呼吸肌麻痹、继发肺部感染者所占比例较高,GBS病情严重程度不同,静脉注射免疫球蛋白(IVIG)、激素治疗者所占比例较高,住院时间较长,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示呼吸肌麻痹(OR=25.590,95%CI:9.433~69.423,P=0.000)、中度GBS(OR=17.030,95%CI:8.441~34.361,P=0.000)、重度GBS(OR=51.042,95%CI:24.596~105.926,P=0.000)是影响GBS合并低钠血症患者短期预后不良的危险因素。结论伴面瘫、呼吸肌麻痹、继发肺部感染、住院时间较长的重度GBS患者更易发生低钠血症。呼吸肌麻痹、中、重度GBS合并低钠血症患者短期预后较差。

Objective To investigate the clinical characteristics of Guillain-Barrésyndrome(GBS)combined with hyponatremia in Southern China and its risk factors for prognosis.Methods The retrospective cohort study involved patients who met the diagnostic criteria of GBS from 18 upper first-class hospitals of 6 provinces/cities in southern China(south of Huaihe River)from January 1,2013 to September 30,2016.The clinical data of these patients were collected.According to serum sodium levels,they were divided into hyponatremia group(serum sodium concentration<135 mmol/L)and normal serum sodium group(serum sodium concentrations≥135 mmol/L).Based on Medical Research Coucil sum scores at nadir,these patients were divided into mild GBS group(>40),moderate GBS group(30-40),and severe GBS group(<30).Furthermore,according to the Hughes GBS disability scale(H-GBS-DS)scores at discharge,these GBS patients with hyponatremia were divided into favorable prognosis group(H-GBS-DS<3)and poor prognosis group(H-GBS-DS≥3).The incidence of hyponatremia in patients from the mild GBS group,moderate GBS group,and severe GBS group were compared.Multivariate Logistic regression analysis was performed to determine the clinical risk factors for hyponatremia in GBS patients.The clinical data of hyponatremia patients from favorable prognosis group and poor prognosis group were compared;multivariate Logistic regression analysis was used to determine the risk factors for poor prognosis in GBS patients with hyponatremia.Results(1)Among the 570 patients,354 had mild GBS,94 had moderate GBS,and 122 had severe GBS;134 GBS patients were combined with hyponatremia,436 GBS patients had normal serum sodium.The hyponatremia incidence in mild,moderate and severe GBS groups increased successively,(P<0.05).Multivariate Logistic regression analysis showed that facial paralysis(OR=1.979,95%CI:1.172-3.342,P=0.011),respiratory muscle paralysis(OR=3.218,95%CI:1.611-6.428,P=0.001),secondary pulmonary infection(OR=4.822,95%CI:2.835-8.201,P=0.000),severe GBS(OR=2.611,95%CI:1.444-4.721,P=0.001)and length of hospital stay(OR=1.029,95%CI:1.009-1.050,P=0.004)were risk factors for hyponatremia in GBS patients.(2)Among 134 GBS patients with hyponatremia,80 had poor prognosis and 54 had favorable prognosis.As compared with the favorable group,the poor prognosis group had significantly lower proportion of patients with extraocular muscle paralysis,statistically higher proportions of patients with respiratory muscle paralysis and secondary pulmonary infection,significantly different severities of GBS,signficantly higher proportion of patients accepted intravenous immunoglobulin(IVIG)and hormone treatments,statistically longer length of hospital stay(P<0.05).Respiratory muscle paralysis(OR=25.590,95%CI:9.433-69.423,P=0.000),moderate GBS(OR=17.030,95%CI:8.441-34.361,P=0.000),and severe GBS(OR=51.042,95%CI:24.596-105.926,P=0.000)were independent risk factors for poor short-term prognosis of GBS patients with hyponatremia.Conclusions Severe GBS patients with facial paralysis,respiratory muscle palsy,secondary pulmonary infection,and long hospital stay trend to have hyponatremia.Hyponatremia patients with respiratory muscle paralysis and moderate/severe GBS have poor short-term prognosis.