伴脑神经功能缺损的吉兰-巴雷综合征临床特征及相关因素分析
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摘要
目的探讨伴脑神经功能缺损的吉兰-巴雷综合征(GBS)的临床特点,以及脑神经功能缺损相关危险因素。方法收集17例伴脑神经功能缺损(脑神经功能缺损组)和30例不伴脑神经功能缺损(对照组) GBS患者的临床资料,回顾性分析比较两组临床特点及相关辅助检查结果,以及引起脑神经功能缺损的相关因素。结果脑神经功能缺损组17例,其中男10例、女7例,平均年龄(36. 71±18. 47)岁,脑神经功能缺损发生率5. 1%。面神经受累11/17例(64. 71%)最为常见。单因素分析:自主神经功能障碍(χ~2=6. 049,P=0. 014)、入院时MCR评分≤30 (χ~2=4. 821,P=0. 028)、呼吸肌麻痹(χ~2=4. 236,P=0. 039)、电生理提示周围神经轴索性损害(χ~2=5. 347,P=0. 021)与GBS患者脑神经受损有关;多因素Logistics回归分析:自主神经功能障碍(OR=4. 800,95%CI:1. 321～17. 441; P=0. 017)与脑神经受损独立相关。结论伴脑神经功能缺损的GBS临床少见,以面神经损伤最为常见;自主神经功能障碍、入院时MCR评分<30、呼吸肌麻痹和电生理提示轴索损害可能与脑神经损伤有关,其中自主神经功能障碍与GBS脑神经损伤独立相关。
Aim To investigate the clinical features and related factors of cranial nerve involved Guillain-Barre syndrome( GBS). Methods Retrospectively analyzed 17 cases of GBS with cranial nerve involved as a research group,30 cases diagnosed GBS inpatients without cranial nerve involvement as a control group,stratifying random pairing rules drawn. Compared clinical data of the two group patients,the clinical differences and further inferred possible risk factors associating with cranial nerve damage of GBS were observed and analyzed. Results 17 cases( 10 males,7 females,mean age 36. 71 ± 18. 47 years),the incidence of cranial nerve involvement was 5. 1%. Among them,the facial nerve involvement in 11 cases( 64. 71%) was the most common. Unvaried analysis found that autonomic dysfunction( χ~2= 6. 049,P = 0. 014),admission MCR score < 30( χ~2= 4. 821,P = 0. 028),respiratory muscle paralysis( χ~2=4. 236,P = 0. 039),peripheral nerve electrophysiology showed axonal damage( χ~2= 5. 347,P = 0. 021)was related with cranial nerve impairment in GBS patients. Multi-logistic regression analysis showed that autonomic dysfunction( OR = 4. 800,95% CI: 1. 321,P = 0. 017) was independently associated with impaired cranial nerve in GBS. Conclusion Cranial nerve involved is rare in GBS patients,facial nerves is the most common. Autonomic dysfunction,admission MCR score < 30,respiratory muscle paralysis and axonal damage may relate with cranial nerve involvement, autonomic dysfunction was independently associated with impaired cranial nerve.
Aim To investigate the clinical features and related factors of cranial nerve involved Guillain-Barre syndrome( GBS). Methods Retrospectively analyzed 17 cases of GBS with cranial nerve involved as a research group,30 cases diagnosed GBS inpatients without cranial nerve involvement as a control group,stratifying random pairing rules drawn. Compared clinical data of the two group patients,the clinical differences and further inferred possible risk factors associating with cranial nerve damage of GBS were observed and analyzed. Results 17 cases( 10 males,7 females,mean age 36. 71 ± 18. 47 years),the incidence of cranial nerve involvement was 5. 1%. Among them,the facial nerve involvement in 11 cases( 64. 71%) was the most common. Unvaried analysis found that autonomic dysfunction( χ~2= 6. 049,P = 0. 014),admission MCR score < 30( χ~2= 4. 821,P = 0. 028),respiratory muscle paralysis( χ~2=4. 236,P = 0. 039),peripheral nerve electrophysiology showed axonal damage( χ~2= 5. 347,P = 0. 021)was related with cranial nerve impairment in GBS patients. Multi-logistic regression analysis showed that autonomic dysfunction( OR = 4. 800,95% CI: 1. 321,P = 0. 017) was independently associated with impaired cranial nerve in GBS. Conclusion Cranial nerve involved is rare in GBS patients,facial nerves is the most common. Autonomic dysfunction,admission MCR score < 30,respiratory muscle paralysis and axonal damage may relate with cranial nerve involvement, autonomic dysfunction was independently associated with impaired cranial nerve.
引文
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[9] Kleyweg RP, van der MechéFG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barrésyndrome[J]. Muscle Nerve, 1991,14:1103-1109
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[11]Albers JW, Kelly JJ Jr. Acquired inflammatory demyelinating polyneuropathies:clinical and electrodiagnostic features[J].Muscle Nerve, 1989, 12:435-451
[12]Hughes RA, Rees JH. Clinical and epidemiological features of Guillain-Barrésyndrome[J]. J Infect Dis, 1997, 176:S92-S98
[13]Korinthenberg R, Schessl J, Kirschner J. Clinical presentation and course of childhood Guillain-Barrésyndrome:a prospective multicentre study[J]. Neuropediatrics,2007, 38:10-7
[14]Lawn ND, Fletcher DD, Henderson RD, et al. Anticipating mechanical ventilation in Guillain-Barrésyndrome[J]. Arch Neurol, 2001, 58:893-898
[15]Verma R, Chaudhari TS, Raut TP, et al. Clinicoelectrophysiological profile and predictors of functional outcome in Guillain-Barrésyndrome(GBS)[J]. J Neurol Sci, 2013,335:105-111
[16]Vucic S, Kiernan MC, Cornblath DR. Guillain-Barrésyndrome:an update[J]. J Clin Neurosci, 2009, 16:733-741
[17]Van Doorn PA, Ruts L, Jacobs BC. Clinical features,pathogenesis, and reatment of Guillain-Barrésyndrome[J].Lancet Neurol, 2008, 7:939-950
[18]McGrogan A, Madle GC, Seaman HE, et al. The epidemiology of Guillain-Barrésyndrome worldwide. A systematic literature review[J]. Neuroepidemiology, 2009, 32:150-163
[19]Khan F,Pallant JF, Ng L, et al. Factors associated with longterm functional outcomes and psychological sequelae in GuillainBarrésyndrome[J]. J Neurol, 2010, 257:2024-2031
[20]Susuki K, Koqa M, Hirata K, et al. A Guillain-Barrésyndrome variant with prominent facial diplegia[J]. J Neurol, 2009, 256:1899-1905
[21]Liu JX, Willison HJ, Pedrosa-Domellf F, et al. Immunolocalization of GQ1b and related ganglosides in human extraocular neuromuscular junctions and muscle spindles[J]. Invest Ophthalmol Vis Sci, 2009, 50:3226-3232
[22]Koga M, Yoshino H, Morimatsu M, et al. Anti-GT1a Ig G in Guillain-Barrésyndrome[J]. J Neurol Neurosurg Psychiatry,2002, 72:767-771
[23]Seta T, Nagayama H, Katsura K, et al. Factors influencing outcome in Guillain-BarréSyndrome:comparison of plasma adsorption against other treatments[J]. Clin Neurol Neurosurg,2005, 107:491-496
[24]Melaku Z, Zenebe G, Bekele A. Guillain-Barrésyndrome in Ethiopian patients[J]. Ethiop Med J, 2005, 43:21-26
[25]Sakakibara R, Uchiyama T, Kuwabara S, et al. Prevalence and mechanism of bladder dysfunction in Guillain-BarréSyndrome[J]. Neurourol Urodyn, 2009, 28:432-437
[26]Witsch J, Galldiks N, Bender A, et al. Long-term outcome in patients with Guillain-Barrésyndrome requiring mechanical ventilation[J]. J Neurol, 2013, 260:1367-1374
[27]Durand M, Porcher R, Orlikowski D, et al. Clinical and electrophysiological predictors of respiratory failure in GuillainBarrésyndrome:a prospective study[J]. Lancet Neurol, 2006,5:1021-1028
[28]Uncini A, Kuwabara S. Electrodiagnostic criteria for GuillainBarrèsyndrome:a critical revision and the need for an update[J]. Clin Neurophysiol, 2012, 123:1487-1495
[29]Katirji B, Koontz D. Disorders of peripheral nerves. In:Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC(eds)Bradley's neurology in clinical practice[M]. 6th edn. Elsevier,Philadelphia, PA, 2012:p 1915-2015
[30]Yuki N, Hartung HP. Guillain-Barrésyndrome[J]. N Engl J Med, 2012, 366:2294-304
[2] Walgaard C, Lingsma HF, Ruts L, et al. Early recognition of poor prognosis in Guillain-Barre syndrome[J]. Neurology, 2011,76:968-975
[3] Susuki K, Koga M, Hirata K, et al. A Guillain-Barrésyndrome variant with prominent facial diplegia[J]. J Neurol, 2009, 256:1899-1905
[4] Gonzlez-Surez I, Sanz-Gallego I, Rodríguez de Rivera FJ.Guillain-BarréSyndrome:natural history and prognostic factors:a retrospective review of 106 cases[J]. BMC Neurology, 2013,13:95
[5] Sejvar JJ, Kohl KS, Gidudu J, et al. Guillain-Barrésyndrome and Fisher syndrome:case definitions and guidelines for collection, analysis, and presentation of immunization safety data[J]. Vaccine, 2011, 29:599-612
[6]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, 43:583-586
[7] Wakerley BR, Uncini A, Yuki N, et al. Guillain-Barréand Miller-Fisher syndromes-new diagnostic classification[J]. Nat Rev Neurol, 2014, 10:537-544
[8] Wakerley BR, Yuki N. Polyneuritis cranialis:oculopharyngeal subtype of Guillain-Barrésyndrome[J]. J Neurol,2015, 262:2001-2012
[9] Kleyweg RP, van der MechéFG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barrésyndrome[J]. Muscle Nerve, 1991,14:1103-1109
[10]杨清成.吉兰-巴雷综合征自主神经损害与病死率的关系探讨[J].中国结合临床, 2011, 17:837-838
[11]Albers JW, Kelly JJ Jr. Acquired inflammatory demyelinating polyneuropathies:clinical and electrodiagnostic features[J].Muscle Nerve, 1989, 12:435-451
[12]Hughes RA, Rees JH. Clinical and epidemiological features of Guillain-Barrésyndrome[J]. J Infect Dis, 1997, 176:S92-S98
[13]Korinthenberg R, Schessl J, Kirschner J. Clinical presentation and course of childhood Guillain-Barrésyndrome:a prospective multicentre study[J]. Neuropediatrics,2007, 38:10-7
[14]Lawn ND, Fletcher DD, Henderson RD, et al. Anticipating mechanical ventilation in Guillain-Barrésyndrome[J]. Arch Neurol, 2001, 58:893-898
[15]Verma R, Chaudhari TS, Raut TP, et al. Clinicoelectrophysiological profile and predictors of functional outcome in Guillain-Barrésyndrome(GBS)[J]. J Neurol Sci, 2013,335:105-111
[16]Vucic S, Kiernan MC, Cornblath DR. Guillain-Barrésyndrome:an update[J]. J Clin Neurosci, 2009, 16:733-741
[17]Van Doorn PA, Ruts L, Jacobs BC. Clinical features,pathogenesis, and reatment of Guillain-Barrésyndrome[J].Lancet Neurol, 2008, 7:939-950
[18]McGrogan A, Madle GC, Seaman HE, et al. The epidemiology of Guillain-Barrésyndrome worldwide. A systematic literature review[J]. Neuroepidemiology, 2009, 32:150-163
[19]Khan F,Pallant JF, Ng L, et al. Factors associated with longterm functional outcomes and psychological sequelae in GuillainBarrésyndrome[J]. J Neurol, 2010, 257:2024-2031
[20]Susuki K, Koqa M, Hirata K, et al. A Guillain-Barrésyndrome variant with prominent facial diplegia[J]. J Neurol, 2009, 256:1899-1905
[21]Liu JX, Willison HJ, Pedrosa-Domellf F, et al. Immunolocalization of GQ1b and related ganglosides in human extraocular neuromuscular junctions and muscle spindles[J]. Invest Ophthalmol Vis Sci, 2009, 50:3226-3232
[22]Koga M, Yoshino H, Morimatsu M, et al. Anti-GT1a Ig G in Guillain-Barrésyndrome[J]. J Neurol Neurosurg Psychiatry,2002, 72:767-771
[23]Seta T, Nagayama H, Katsura K, et al. Factors influencing outcome in Guillain-BarréSyndrome:comparison of plasma adsorption against other treatments[J]. Clin Neurol Neurosurg,2005, 107:491-496
[24]Melaku Z, Zenebe G, Bekele A. Guillain-Barrésyndrome in Ethiopian patients[J]. Ethiop Med J, 2005, 43:21-26
[25]Sakakibara R, Uchiyama T, Kuwabara S, et al. Prevalence and mechanism of bladder dysfunction in Guillain-BarréSyndrome[J]. Neurourol Urodyn, 2009, 28:432-437
[26]Witsch J, Galldiks N, Bender A, et al. Long-term outcome in patients with Guillain-Barrésyndrome requiring mechanical ventilation[J]. J Neurol, 2013, 260:1367-1374
[27]Durand M, Porcher R, Orlikowski D, et al. Clinical and electrophysiological predictors of respiratory failure in GuillainBarrésyndrome:a prospective study[J]. Lancet Neurol, 2006,5:1021-1028
[28]Uncini A, Kuwabara S. Electrodiagnostic criteria for GuillainBarrèsyndrome:a critical revision and the need for an update[J]. Clin Neurophysiol, 2012, 123:1487-1495
[29]Katirji B, Koontz D. Disorders of peripheral nerves. In:Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC(eds)Bradley's neurology in clinical practice[M]. 6th edn. Elsevier,Philadelphia, PA, 2012:p 1915-2015
[30]Yuki N, Hartung HP. Guillain-Barrésyndrome[J]. N Engl J Med, 2012, 366:2294-304