伴有感觉平面的抗GM4-IgM抗体阳性吉兰-巴雷综合征1例报告

Guillain-Barrésyndrome with a sensory level and positive anti-GM4-IgM antibody

吉兰-巴雷综合征(GBS)是一类免疫介导的急性炎性周围神经病,大多表现为急性、对称性、弛缓性、麻痹性多神经根及周围神经病变,伴或不伴脑神经受累。最常见的两个亚型为急性炎性脱髓鞘性多发性神经根神经病(AIDP),急性运动轴索型神经病(AMAN)。其他少见类型包括:急性感觉运动轴索型神经病(AMSAN)、MillerFisher综合征(MFS)等。同时越来越多的变异形式,如咽颈臂型、多发脑神经型、截瘫型等被报道。因此,GBS被逐渐地认识到是一个疾病谱。既往研究发现并被证实神经节苷脂抗体与GBS相关,包括GM1、GM2、GM3、GM4、GD1a、GD1b、GT1a、GT1b、GQ1b等。而国内外关于伴有感觉平面的GBS的文献报道极少。本研究报道1例抗GM4IgM抗体阳性的胃肠道术后具有感觉平面的GBS患者,在既往研究中未见报道,旨在提高对此病的认识,减少误诊。

Guillain-Barrésyndrome(GBS)is an immune-mediated acute inflammatory peripheral neuropathy.It primarily manifests as acute,symmetrical,flaccid paralysis of multiple nerve roots and peripheral neuropathy,with or without cranial nerve involvement.The two most common subtypes of GBS are acute inflammatory demyelinating polyneuropathy(AIDP)and acute motor axonal neuropathy(AMAN).Other less common types include acute motor sensory axonal neuropathy(AMSAN)and Miller-Fisher syndrome(MFS).In addition,other variants,such as pharyngeal-cervicalbrachial variant,multiple cranial neuropathy,and paraplegia,have been increasingly reported.Therefore,GBS is gradually being recognized as a spectrum of diseases.Previous studies have found and confirmed that ganglioside antibodies are associated with GBS,including anti-GM1,anti-GM2,anti-GM3,anti-GM4,anti-GD1a,anti-GD1b,anti-GT1a,anti-GT1b,and anti-GQ1b antibodies.However,GBS with a sensory level has been rarely reported.This report presents a case of anti-GM4 IgM-positive GBS with a sensory level following gastrointestinal surgery,which has not been previously reported.The findings of this study may help enhance awareness of this disease and reduce misdiagnosis.