新型冠状病毒感染相关吉兰-巴雷综合征4例

Four cases of COVID-19 associated Guillain-Barrésyndrome

新型冠状病毒(SARS-CoV-2)感染(COVID-19)后伴发周围神经损害引起的COVID-19相关吉兰-巴雷综合征(GBS)是最常见的COVID-19相关神经系统炎性疾病之一,有较高的呼吸衰竭发生率及病死率。既往COVID-19相关GBS患者脑脊液中SARS-CoV-2 RNA阳性报道罕见。文中报道4例COVID-19相关GBS患者,在出现发热等症状并确诊COVID-19后4~15 d出现神经系统症状,均表现为进展性双下肢无力,3例患者伴有大小便障碍等自主神经功能损害表现,1例患者伴有双侧面神经麻痹、吞咽困难、复视和共济失调等多脑神经炎及Miller-Fisher综合征表现。神经电生理检查3例患者出现神经传导速度异常及F波出现率减低,另外1例患者存在下肢运动传导通路异常。有3例患者行抗神经节苷脂抗体检查,其中1例患者血GD1a-IgG阳性。对4例患者均行血液、脑脊液宏基因组二代测序检查,3例患者血液及脑脊液SARS-CoV-2 RNA阳性,1例患者脑脊液SARS-CoV-2 RNA阳性。

COVID-19 associated Guillain-Barrésyndrome(GBS)caused by peripheral nerve damage after SARS-CoV-2 infection is one of the most common COVID-19 related nervous system inflammatory diseases,with high incidence of respiratory failure and mortality.Positive SARS-CoV-2 RNA in cerebrospinal fluid of COVID-19 associated GBS patients has been rarely reported.This paper reports 4 patients with COVID-19 associated GBS in China who developed neurological symptoms 4-15 days after fever and were confirmed SARS-CoV-2 infection.All patients presented with progressive weakness of both lower limbs,3 patients with autonomic dysfunction such as defecation and urination disorders,and 1 patient with polycranial neuritis and Miller-Fisher syndrome such as bilateral facial palsy,dysphagia,diplopia and ataxia.Nerve conduction velocity and F wave were abnormal in 3 patients,and motor conduction pathway was abnormal in 1 patient.Anti-ganglioside antibodies were tested in 3 patients,and GD1a-IgG was positive in 1 patient.All 4 patients underwent metagenomic next-generation sequencing examination in blood and cerebrospinal fluid.SARS-CoV-2 RNA was positive in blood and cerebrospinal fluid of 3 patients,and SARS-CoV-2 RNA was positive in cerebrospinal fluid of 1 patient.