妊娠型和非妊娠型吉兰-巴雷综合征的对比研究
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摘要
目的探究妊娠型吉兰-巴雷综合征(GBS)的临床特点、治疗和预后。方法纳入女性GBS患者75例,依据是否妊娠将患者分为妊娠组和非妊娠组。患者均接受静脉注射免疫球蛋白(IVIg)治疗。对比两组患者的临床特点、IVIg的疗效并分析母婴结局。结果妊娠组较非妊娠组更易出现自主神经功能障碍(P=0. 000),临床以心律失常(P=0. 015)和肢体水肿(P=0. 029)多见。IVIg治疗后,妊娠组和非妊娠组的好转天数分别为(5. 0±1. 4和7. 8±3. 4)(P=0. 004);基本治愈天数分别为(10. 3±3. 4和18. 6±5. 4)(P=0. 096);临床治愈天数分别为(18. 9±6. 6和25. 7±8. 2)(P=0. 119)。颜面潮红、一过性发热、恶心及瘙痒是最常见的IVIg治疗并发症。妊娠患者随访,足月分娩26例,早产4例。婴幼儿均体健,无先天畸形。结论妊娠型GBS临床特点同非妊娠型GBS相似,多为单一、良性病程,较易出现自主神经功能障碍。IVIg治疗总体安全、有效。母婴多预后良好。
Objective To explore the clinical features,treatment and prognosis of pregnancy complicating GuillainBarre syndrome( GBS). Methods The clinical data of 75 female GBS patients were analyzed,and patients were divided into the pregnancy group and non-pregnancy group. The clinical features,efficacy of intravenous immunoglobulin( IVIg)were compared between the two groups,and the maternal and fetal outcomes were analyzed. Results The pregnancy group was more prone to autonomic nerve dysfunction( P = 0. 000). The improvement days of pregnancy group and the non-pregnancy group were( 5. 0 ± 1. 4 and 7. 8 ± 3. 4)( P = 0. 004),the basic cure days were( 10. 3 ± 3. 4 and 18. 6 ± 5. 4)( P =0. 096),the cure days were( 18. 9 ± 6. 6 and 25. 7 ± 8. 2)( P = 0. 119),respectively. Facial blushing,transient fever,nausea and pruritus are the most common IVIg complications. Thirty pregnant patients were followed up,including 26 cases of full-term delivery and 4 cases of preterm birth. The fetus was healthy without congenital malformation. Conclusions The clinical features of non-pregnancy and pregnancy complicating GBS was similar,and the pregnancy was more prone to autonomic nerve dysfunction. IVIg is generally safe and effective. The prognosis for most mothers and infants is good.
Objective To explore the clinical features,treatment and prognosis of pregnancy complicating GuillainBarre syndrome( GBS). Methods The clinical data of 75 female GBS patients were analyzed,and patients were divided into the pregnancy group and non-pregnancy group. The clinical features,efficacy of intravenous immunoglobulin( IVIg)were compared between the two groups,and the maternal and fetal outcomes were analyzed. Results The pregnancy group was more prone to autonomic nerve dysfunction( P = 0. 000). The improvement days of pregnancy group and the non-pregnancy group were( 5. 0 ± 1. 4 and 7. 8 ± 3. 4)( P = 0. 004),the basic cure days were( 10. 3 ± 3. 4 and 18. 6 ± 5. 4)( P =0. 096),the cure days were( 18. 9 ± 6. 6 and 25. 7 ± 8. 2)( P = 0. 119),respectively. Facial blushing,transient fever,nausea and pruritus are the most common IVIg complications. Thirty pregnant patients were followed up,including 26 cases of full-term delivery and 4 cases of preterm birth. The fetus was healthy without congenital malformation. Conclusions The clinical features of non-pregnancy and pregnancy complicating GBS was similar,and the pregnancy was more prone to autonomic nerve dysfunction. IVIg is generally safe and effective. The prognosis for most mothers and infants is good.
引文
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[10]Ying Wang,Wenjuan Lang.Long-term prognosis of Guillain-Barre syndrome not determined by treatment options[J].Oncotarget,2017,8(45):79991-80001.
[2]柳胤,楼敏,邵蓓,等.中国南方吉兰-巴雷综合征的临床特点及Brighton分层诊断:基于四年期间1358例住院患者的回顾性分析[J].中华神经科杂志,2018,51(2):85-90.
[3]朱莹,周夏俊,管阳太.Miller-Fisher综合征与Guillain-Barre综合征非核心临床表现、电生理及脑脊液比较[J].中国神经免疫学和神经病学杂志,2018,25(1):22-25.
[4]Nathalie Auger,Caroline Quach,Jessica Healy-Profitos,et al.Early predictors of Guillain-Barre syndrome in the life course of women[J].Int J Epidemiol,2018,47(1):280-288.
[5]Ying Wang,Wenjuan Lang,Yaqian Zhang,et al.Long-term prognosis of Guillain-Barre syndrome not determined by treatment options[J].Oncotarget,2017,8(45):79991-80001.
[6]Sylvie Chevret,Richard AC Hughes,Djillali Annane.Plasma exchange for Guillain-Barre syndrome[J].Cochrane Database Syst Rev,2017,2017(2):CD001798.
[7]Anupam Gupta,Maitreyi Patil,Meeka Khanna,et al.Guillain-Barre syndrome in postpartum period:rehabilitation issues and outcomethree case reports[J].J Neurosci Rural Pract,2017,8(3):475-477.
[8]Jane Pritchard,Robert DM Hadden,Ruth Brassington,et al.Pharmacological treatment other than corticosteroids,intravenous immunoglobulin and plasma exchange for Guillain-Barre syndrome[J].Cochrane Database Syst Rev,2016,9(11):CD008630.
[9]Kalita J,Ranjan A,Misra UK.Outcome of Guillain-Barre syndrome patients with respiratory paralysis[J].QJM-An International Journal of Medicine,2016,109(5):319-323.
[10]Ying Wang,Wenjuan Lang.Long-term prognosis of Guillain-Barre syndrome not determined by treatment options[J].Oncotarget,2017,8(45):79991-80001.