滇东北地区112例吉兰-巴雷综合征单中心回顾性分析

Guillain-Barre syndrome in northeastern Yunnan Province,China:A single-center retrospective analysis of 112 cases

目的本研究旨在探究云南滇东北地区吉兰-巴雷综合征(GBS)患者临床特点,以期为该地区GBS提供临床诊治依据。方法本研究回顾性分析2018年2月-2022年10月曲靖市第一人民医院神经内科GBS住院患者的临床资料,患者主要来自中国滇东北地区。本研究也对中国近年报道的各地区GBS临床特点进行对比。结果本研究共回顾性纳入112例符合条件的患者,其中AIDP 49例,AMAN 33例,本组患者春冬两季较高发,以春季为主(38例,33.9%),AIDP多见于冬季(15例,30.6%),AMAN多见于春季(14例,42.4%)。GBS患者的中位发病年龄为56岁(范围:8~83岁),在60~69岁年龄达到峰值。男女患病比为1.60(69∶43),上呼吸道感染(25例,22.3%)和肠胃炎(14例,12.5%)为最常见的前驱感染事件。AIDP为最常见的亚型(49例,51.6%),AIDP与AMAN两组在发病年龄、前驱感染事件、初始症状、临床表现、脑脊液蛋白水平、治疗效果等方面无统计学差异(P>0.05)。12例患者(10.7%)在疾病高峰时需要机械通气,机械通气组患者颅神经受累比例,尤其是吞咽困难患者比例较非机械通气组更高(75.0%vs 32.0%,P=0.0081)。中国南部、东部及大理地区、滇东北地区GBS患者主要以上呼吸道感染为主要前驱事件(22%~35%),而北方地区胃肠炎比例较高(24%)。AMAN为中国北部(40%)和东部(35%)的主要GBS亚型,而AIDP为中国南部(49%)的主要亚型。结论GBS存在地区差异,滇东北地区GBS亚型仍以脱髓鞘型为主;患者发病年龄以60~69岁男性为主,呈现双峰分布特点;胃肠道和呼吸道感染仍是本地区GBS的主要前驱事件。颅神经受累,尤其是球部肌肉受累与机械通气风险可能相关。

Objective To explore the clinical characteristics of patients with Guillain-Barrésyndrome(GBS)in northeastern Yunnan Province,China,and to provide a basis for clinical diagnosis and treatment of GBS in this region.Methods We retrospectively analyzed the clinical data of inpatients with GBS in the Department of Neurology,Qujing No.1 Hospital from February 2018 to October 2022,who were mainly from the northeastern regions of Yunnan Province.We compared the clinical characteristics of GBS reported in different regions of China in recent years.Results A total of 112 patients meeting the criteria were retrospectively included in this study,including 49 cases of acute inflammatory demyelinating polyneuropathy(AIDP)and 33 cases of acute motor axonal neuropathy(AMAN).In this cohort of patients,GBS occurred frequently in spring and winter,especially in spring(38 cases,33.9%).AIDP was more common in winter(15 cases,30.6%),while AMAN was more common in spring(14 cases,42.4%).The median age of onset was 56 years(range:8 to 83 years),peaking at the age of 60 to 69 years.The male-tofemale ratio was 1.60(69∶43).Upper respiratory tract infection(25 cases,22.3%)and gastroenteritis(14 cases,12.5%)were the most common among prodromal infections.AIDP was the most common subtype(49 cases,51.6%).There were no significant differences between the AIDP and AMAN groups in age of onset,prodromal infection,initial symptoms,clinical manifestations,cerebrospinal fluid protein levels,or therapeutic effects(P>0.05).Twelve patients(10.7%)required mechanical ventilation at nadir.The patients with mechanical ventilation had higher proportions of cranial nerve involvement compared with those without mechanical ventilation,especially in the proportion of dysphagia(75.0%vs 32.0%,P=0.0081).Upper respiratory tract infection was the main prodromal event of GBS in Dali of Yunnan Province and the southern and eastern regions of China,where the proportions ranged from 22%to 35%.Gastroenteritis was more common in the northern region of China,accounting for 24%.