吉兰-巴雷综合征急性期疼痛的发生率及其临床意义--附中国鲁西南地区单中心226例分析

Incidence and clinical significance of acute pain in patients with Guillain-Barrésyndrome in Southwestern Shandong Province of China:226 cases of a single-center study

目的分析中国鲁西南地区吉兰-巴雷综合征(GBS)患者急性期疼痛的发生率及其与GBS临床特征、临床分型及抗神经节苷脂抗体的关系,探讨GBS急性期疼痛的临床意义。方法纳入226例GBS患者,收集其临床资料,并进行为期1年的随访,比较伴与不伴急性期疼痛患者的临床特征、临床分型及抗神经节苷脂抗体等方面的差异。结果226例GBS患者中男121例、女105例,19.9%(45/226)伴有急性期疼痛,46.5%(105/226)有前驱感染史,82.7%(187/226)存在肢体无力,51.8%(117/226)存在感觉障碍,73.2%(145/198)腰椎穿刺结果显示有脑脊液蛋白-细胞分离现象,46.8%(96/205)抗神经节苷脂抗体IgG阳性。44.7%(101/226)患者为经典型(运动-感觉)GBS,39.4%(89/226)为纯运动型GBS。伴有急性期疼痛患者上呼吸道感染者的比例低于不伴疼痛者(P=0.029),在临床特征、临床分型和抗神经节苷脂抗体阳性率方面两者无差异(P均>0.05)。结论除了上呼吸道感染方面,伴有急性期疼痛的GBS患者在临床特征和预后方面与不伴疼痛者无差异,建议对GBS的类型、分级作进一步细化研究。

Objective To investigate the incidence of pain in patients with Guillain-Barrésyndrome(GBS)during acute phase and analyze its relationship with clinical features,clinical variants and anti-ganglioside antibodies in patients from Southwestern Shandong Province,aiming to explore the clinical significance of acute pain in GBS.Methods 226 patients with GBS were enrolled in this prospective observational clinical study.Clinical data were collected,and all patients were followed up for one year.The differences in clinical features,clinical variants and anti-ganglioside antibodies between patients with and without pain during acute phase were analyzed.Results Among 226 GBS patients,121 were male and 105 were female.45 patients(19.9%)had pain during acute phase,46.5%(n=105)developed antecedent infection,82.7%(n=187)experienced limb weakness and 51.8%(n=117)had sensory deficits.73.2%(145/198)presented with albuminocytological dissociation in the cerebrospinal fluid.46.8%(96/205)were positive for anti-ganglioside antibody IgG.44.7%(n=101)were diagnosed with classic motor-sensory GBS and 39.4%(89/226)with pure motor GBS.The proportion of upper respiratory tract infection in GBS patients with pain was significantly lower than that in those without pain(P=0.029).There was no significant difference in clinical features,clinical variants and positive rate of anti-ganglioside antibodies between patients with and without pain during acute phase(all P>0.05).Conclusions Except for the upper respiratory tract infection,no significant difference is observed in clinical features and prognosis between GBS patients with and without pain during acute phase.The types and classifications of GBS deserve further validation.