肾癌及脑膜瘤术后并发吉兰-巴雷综合征1例
|
摘要
<正>吉兰-巴雷综合征(Guillain-Barre syndrome,GBS)是一种周围神经髓鞘脂蛋白或轴突受损的自身免疫性疾病[1],临床特征为急性起病,表现为多发神经根及周围神经损害,多呈单时相自限性病程。多并发于感染后,常见的病原菌包括空肠弯曲菌、巨细胞病毒、EB病毒和流感病毒等,此外也有以妊娠、疫苗接种[2]和手术为诱因者[3]。GBS在西方国家年发病率为(1. 1～1. 8)/100 000人,中国为0. 66/100 000人,而术后发生GBS较为少见,在所有GBS发生率中仅占5%[4]。关于术后出现GBS的报道见
Guillain-Barre syndrome(GBS) is an autoimmune disease on the injury of peripheral nerve myelin proteins or axon,of which the acute motor axonal neuropathy(AMAN) as a subtype is of infrequence and an extremely low incidence of post-operation.This article originally reported one case from Peking University People's Hospital on successful treatment of severe GBS(AMAN) on post-operation with renal carcinoma and meningioma.The diagnostic criteria of AMAN refer to AIDP,of which the feature of AMAN suggests a pure motor nerve dysfunction and significant damage on motor axon.It is reported that infection and surgery may induce GBS.The positive result of IgM and IgG was considered the application of ganglioside and blood-brain barrier might be damaged after meningioma surgery which eased the drug to enter the cerebrospinal fluid circulation and induced lesions,therefore the etiology on this GBS case was of high confidence of administrating ganglioside drugs.Autonomic nerve dysfunctions,such as blood pressure fluctuations and arrhythmia could be caused in GBS,of which about 3%-10% of GBS patients would die.Early use of gamma globulin or plasma exchange was recommended internationally,but recently some new ideas,to some extent,of significance on GBS treatment emerged.However,there was still no consensus on GBS treatment systematically all over the world.Till now,the general treatment program on GBS may be still gamma globulin or plasma exchange and a curious judgment of prognosis is essential in order to make a reasonable plan.That it was usually of no omen on severe autonomic nerve dysfunction must be successively monitored,the same as the management of the respiratory tract and nutrition support.The key measures taken on lung recruitment was postural drainage on this case with a low cost but a qualified effectiveness.This case report aimed to deepen the understanding of AMAN and acquaint the cutting-edge advances on the treatment of GBS,as well as providing successful treatment experience for the prevention on similar cases.
Guillain-Barre syndrome(GBS) is an autoimmune disease on the injury of peripheral nerve myelin proteins or axon,of which the acute motor axonal neuropathy(AMAN) as a subtype is of infrequence and an extremely low incidence of post-operation.This article originally reported one case from Peking University People's Hospital on successful treatment of severe GBS(AMAN) on post-operation with renal carcinoma and meningioma.The diagnostic criteria of AMAN refer to AIDP,of which the feature of AMAN suggests a pure motor nerve dysfunction and significant damage on motor axon.It is reported that infection and surgery may induce GBS.The positive result of IgM and IgG was considered the application of ganglioside and blood-brain barrier might be damaged after meningioma surgery which eased the drug to enter the cerebrospinal fluid circulation and induced lesions,therefore the etiology on this GBS case was of high confidence of administrating ganglioside drugs.Autonomic nerve dysfunctions,such as blood pressure fluctuations and arrhythmia could be caused in GBS,of which about 3%-10% of GBS patients would die.Early use of gamma globulin or plasma exchange was recommended internationally,but recently some new ideas,to some extent,of significance on GBS treatment emerged.However,there was still no consensus on GBS treatment systematically all over the world.Till now,the general treatment program on GBS may be still gamma globulin or plasma exchange and a curious judgment of prognosis is essential in order to make a reasonable plan.That it was usually of no omen on severe autonomic nerve dysfunction must be successively monitored,the same as the management of the respiratory tract and nutrition support.The key measures taken on lung recruitment was postural drainage on this case with a low cost but a qualified effectiveness.This case report aimed to deepen the understanding of AMAN and acquaint the cutting-edge advances on the treatment of GBS,as well as providing successful treatment experience for the prevention on similar cases.
引文
[1]Hartung HP,Willison HJ,Kieseier BC.Acute immunoinflammatory neuropathy:update on Guillain-Barre syndrome[J].Curr Opin Neurol,2002,15(5):571-577.
[2]Schonberger LB,Hurwitz ES,Katona P,et al.Guillain-Barre syndrome:its epidemiology and associations with influenza vaccination[J].Ann Neurol,1981,9(Suppl):31-38.
[3]Gensicke H,Datta AN,Dill P,et al.Increased incidence of Guillain-Barre syndrome after surgery[J].Eur J Neurol,2012,19(9):1239-1244.
[4]El-Bayoumi MA,El-Refaey AM,Abdelkader AM,et al.Comparison of intravenous immunoglobulin and plasma exchange in treatment of mechanically ventilated children with Guillain-Barre syndrome:a randomized study[J].Crit Care,2011,15(4):R164.
[5]Algahtani H,Moulin DE,Bolton CF,et al.Guillain-Barre syndrome following cardiac surgery.Difficult diagnosis in the intensive care unit[J].Neurosciences(Riyadh),2009,14(4):374-378.
[6]Papantoni E,Sakorafas GH,Zouros E,et al.Guillain-Barre syndrome following total gastrectomy/esophagectomy:a very rare and dramatic post-operative complication with a favourable outcome[J].ANZ J Surg,2010,80(11):858.
[7]Hendawi T,Zavatsky JM.Guillain-Barre syndrome after pelvic fracture fixation:a rare cause of postoperative paralysis[J].Spine(Phila Pa 1976),2015,40(6):E372-E374.
[8]Yuki N,Hartung HP.Guillain-Barre syndrome[J].N Engl JMed,2012,366(24):2294-2304.
[9]Asbury AK,Cornblath DR.Assessment of current diagnostic criteria for Guillain-Barre syndrome[J].Ann Neurol,1990,27(Suppl):21-24.
[10]中华医学会神经病学分会神经肌肉病学组,中华医学会神经病学分会肌电图及临床神经电生理学组,中华医学会神经病学分会神经免疫学组.中国吉兰-巴雷综合征诊治指南[J].中华神经科杂志,2010,43(8):583-586.
[11]Pithadia AB,Kakadia N.Guillain-Barre syndrome(GBS)[J].Pharmacol Rep,2010,62(2):220-232.
[12]Walgaard C,Lingsma HF,Ruts L,et al.Early recognition of poor prognosis in Guillain-Barre syndrome[J].Neurology,2011,76(11):968-975.
[13]李胜.以麻痹性肠梗阻为首发表现的吉兰-巴雷综合征一例[J].中华急诊医学杂志,2009,18(6):627.
[14]Ruts L,van Doorn PA,Lombardi R,et al.Unmyelinated and myelinated skin nerve damage in Guillain-Barre syndrome:correlation with pain and recovery[J].Pain,2012,153(2):399-409.
[15]杨伟民,方媛,刘鸣.吉兰-巴雷综合征循证治疗进展[J].国际神经病学神经外科学杂志,2008,35(3):258-260.
[16]Hughes RA,Swan AV,Raphael JC,et al.Immunotherapy for Guillain-Barre syndrome:a systematic review[J].Brain,2007,130(Pt 9):2245-2257.
[2]Schonberger LB,Hurwitz ES,Katona P,et al.Guillain-Barre syndrome:its epidemiology and associations with influenza vaccination[J].Ann Neurol,1981,9(Suppl):31-38.
[3]Gensicke H,Datta AN,Dill P,et al.Increased incidence of Guillain-Barre syndrome after surgery[J].Eur J Neurol,2012,19(9):1239-1244.
[4]El-Bayoumi MA,El-Refaey AM,Abdelkader AM,et al.Comparison of intravenous immunoglobulin and plasma exchange in treatment of mechanically ventilated children with Guillain-Barre syndrome:a randomized study[J].Crit Care,2011,15(4):R164.
[5]Algahtani H,Moulin DE,Bolton CF,et al.Guillain-Barre syndrome following cardiac surgery.Difficult diagnosis in the intensive care unit[J].Neurosciences(Riyadh),2009,14(4):374-378.
[6]Papantoni E,Sakorafas GH,Zouros E,et al.Guillain-Barre syndrome following total gastrectomy/esophagectomy:a very rare and dramatic post-operative complication with a favourable outcome[J].ANZ J Surg,2010,80(11):858.
[7]Hendawi T,Zavatsky JM.Guillain-Barre syndrome after pelvic fracture fixation:a rare cause of postoperative paralysis[J].Spine(Phila Pa 1976),2015,40(6):E372-E374.
[8]Yuki N,Hartung HP.Guillain-Barre syndrome[J].N Engl JMed,2012,366(24):2294-2304.
[9]Asbury AK,Cornblath DR.Assessment of current diagnostic criteria for Guillain-Barre syndrome[J].Ann Neurol,1990,27(Suppl):21-24.
[10]中华医学会神经病学分会神经肌肉病学组,中华医学会神经病学分会肌电图及临床神经电生理学组,中华医学会神经病学分会神经免疫学组.中国吉兰-巴雷综合征诊治指南[J].中华神经科杂志,2010,43(8):583-586.
[11]Pithadia AB,Kakadia N.Guillain-Barre syndrome(GBS)[J].Pharmacol Rep,2010,62(2):220-232.
[12]Walgaard C,Lingsma HF,Ruts L,et al.Early recognition of poor prognosis in Guillain-Barre syndrome[J].Neurology,2011,76(11):968-975.
[13]李胜.以麻痹性肠梗阻为首发表现的吉兰-巴雷综合征一例[J].中华急诊医学杂志,2009,18(6):627.
[14]Ruts L,van Doorn PA,Lombardi R,et al.Unmyelinated and myelinated skin nerve damage in Guillain-Barre syndrome:correlation with pain and recovery[J].Pain,2012,153(2):399-409.
[15]杨伟民,方媛,刘鸣.吉兰-巴雷综合征循证治疗进展[J].国际神经病学神经外科学杂志,2008,35(3):258-260.
[16]Hughes RA,Swan AV,Raphael JC,et al.Immunotherapy for Guillain-Barre syndrome:a systematic review[J].Brain,2007,130(Pt 9):2245-2257.