以小纤维感觉神经受累为主的格林-巴利综合征

Small fibre sensory neuropathy:the variant type of Guillain-Barre syndrome

目的 探讨以小纤维感觉神经受累为主的格林 巴利综合征患者的临床特点和治疗方法。方法 回顾性分析 4例以麻木疼痛为主诉的格林 巴利综合征患者的临床资料。 4例均进行相应的电生理测试和相关实验室检查。结果 4例均有病前感染史 ,麻木起病 ,5～ 14d内病情达高峰 ;脑脊液分析示蛋白细胞分离。脑脊液 2 4hIgG增高 3例 ,寡克隆区带 (OB)阳性 2例。常规感觉神经传导速度 (SCV)正常 ,运动神经传导速度 (MCV)和 (或 )末端潜伏期 (ML)减慢 3例 ,正常 1例 ,正中神经F波传导速度减慢 3例 ,胫后神经F波潜伏期延长 2例 ,4例F波出现率均低于正常 ,针极肌电图 2例正常 ,2例胫前肌大力收缩时为单纯相 ;上下肢交感神经皮肤反应 (SSR)均在正常范围内。预后良好 ,使用丙种球蛋白治疗的患者 ,麻木疼痛感恢复较使用激素治疗者快。随诊 6个月后 ,1例患者仍有麻木感存在。结论 对临床表现为麻木和疼痛的格林 巴利综合征患者 ,在除外交感神经节后纤维受累的情况下 ,应考虑小纤维感觉神经受累。早期丙种球蛋白的使用可能有助于感觉异常的恢复。

Objective To explore the clinical features and therapeutic measures to the patients with the variant type of Guillain Barre syndrome (small fibre sensory neuropathy).Methods Four GBS patients who had subacute onset of numbness and pain were studied by use of electrophysiological methods and related laboratory tests.Results All patients had infected disease before GBS,two of them had related burning or prick of the sickness dysaethesia.All of them reachad the peak point within 2 weeks.Analysis of CSF demonstrated albumino cytological dissociation in all patients.Routine sensory nerve conduction (SCV) studies and sympathetic skin response (SSR) were normal in all patients.Two of four patients with painful dysaesthesia recovered within 6 weeks,and 1 of 4 patients with numbness and objective sensory loss tended to persist longer.Conclusions GBS patients who have onset with numbness and pain,when SCV and SSR are normal,should be considered as another variant type of GBS (small fibre sensory neuropathy).