HIV感染合并吉兰-巴雷综合征8例临床分析

Clinical analysis of 8 HIV infected patients with Guillain-Barrésyndrome

目的探讨人类免疫缺陷病毒(HIV)感染合并吉兰-巴雷综合征(GBS)的临床特点。方法回顾性分析首都医科大学附属北京地坛医院2013年1月至2020年12月诊治的8例HIV感染合并GBS患者的临床资料及实验室检查特点,并进行相关文献复习。结果8例均为男性,年龄21~68岁,病例2为HIV急性感染期,病例5、病例7为HIV慢性感染期,病例3、4为获得性免疫缺陷综合征(AIDS)期,病例1、病例6、病例8 GBS做为HIV感染的首发症状出现。8例均具有肢体无力,除病例3外,其它7例合并感觉障碍,病例3、4、6出现颅神经受累,病例1因呼吸肌麻痹行气管插管。病例1、2、3、4及病例8患者脑脊液蛋白明显增高、白细胞轻度增高,病例5患者脑脊液蛋白增高、细胞正常。病例3、5、6发现近期肺炎支原体感染,病例2近期单纯疱疹病毒感染,病例4脑脊液宏基因测序发现EB病毒。治疗上,病例3、4、7、8单独使用静脉注射免疫球蛋白(IVIG),病例6联合使用IVIG及甲泼尼龙,病例1联合使用IVIG及血浆置换。病例5首次发病时单独使用IVIG症状部分改善,再次发病时联合使用IVIG及甲泼尼龙治疗。病例1拔出气管插管,恢复良好。病例2拒绝治疗,自动出院。病例3及病例4部分改善,病例5出院后出现肢体无力加重,联合使用IVIG及甲泼尼龙后好转,病例6、7、8完全恢复。结论GBS可发生在HIV感染各个时期,并可以HIV感染首发症状出现,HIV感染合并GBS与普通人群症状类似,对于IVIG及血浆置换反应较好,对于GBS患者应考虑HIV感染可能。

Objective To discuss the clinical characteristics of GBS in HIV-infected patients.Methods In this study we reviewed the clinical data of HIV-infected patients with a diagnosis of GBS attending to Beijing Ditan Hospital from January 2013 to December 2020,and reviewed the literature on this topic.Results We identified eight patients,all are male,aged 28 to 49 years.One patient occurs early in HIV infection,two patient occurs in chronic phase of HIV infection,two patient occurs in AIDS.GBS was the first symptom of HIV infection in three patient.All patients had limbs weakness,seven patients had paresthesias or sensory loss,cranial nerve abnormalities were observed in three patients,one patient has mechanical ventilation.CSF results were available in nine patients,CSF white blood cell was 11~16 cells/μl in six patients,3~5 cells/μl in two patients.CSF protein was increased in six patients and normal in two patients.Recent mycoplasma pneumoniae infection was found in patients 3,5,and 6,recent herpes simplex virus infection in patients 2,and EB virus was found in patients 4 cerebrospinal fluid.Four patients received 5 days of IVIG treatment,one patient was treated with IVIg and steroids,one patient received IVIG and plasmapheresis.Patients 5 had recurrent weakness from 10 weeks after the onset of symptoms.Four patients had improved during the course of treatment,three patients had full recovery.Conclusion HIV-GBS occurs in early and late stages of HIV infection,and may follow the onset of AIDS,Clinical signs of GBS are similar for patients regardless of their HIV status,most patients have a good recovery when they received IVIG or plasmapheresis.This case highlighted the need for all clinicians to be aware that patients with symptoms of GBS,regardless of clinical history should be offered an HIV test.