格林—巴利综合征的流行性及其危险因素
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摘要
本文主要研究2007年长春市双阳地区GBS区域性暴发流行时,收治于吉林大学第一医院的33例患者,通过回顾性分析,记录全部病例的年龄、性别、前驱病史、首发症状、运动症状、感觉症状、波及颅神经、腱反射情况、呼吸肌受累情况、发病至高峰时间、高峰持续时间、住院时间及辅助检查结果,描述其总体特点及此次儿童GBS患者的临床特点,并与同年散发GBS患者进行比较,总结出本次GBS的流行病学特点,讨论可能引起此次事件的主要危险因素。结果示双阳地区此次GBS属区域性暴发流行,人禽共患,发病时间集中在2007年6月21日至2007年7月6日,患者集中居住于西南部城区与农村交界处,发病率8.76/10万人口,男性多于女性,10～20岁多发,0～5岁患儿无发病者;本次事件的发生与罕见的高温少雨天气有关,不能除外水源污染的可能,病原体尚不能完全肯定,推测可能为空肠弯曲菌;此次GBS临床特点与散发患者无差别。
Guillain-Barrésyndrome is reported as la paralysie aschandante aigue by French academician Landry in 1859 at the very beginning. Following lots of researches,it is founded that GBS is disorders of peripheral nerves mediated by immune. The main pathological changes to peripheral nerve cells was the infiltration of lymphocyte and megaphocyte,while to nerve fibers was segmental demyelination and axonal degeneration. Nearly a century's time, the large number of domestic and foreign scholars study heavily and deeply on the aspects of epidemiology, pathological changes, etiology, pathogenesis, clinical characteristics, treatment of GBS. GBS was broken out between mid-June,2007 and July in Shuangyang district of Changchun City,Jilin Province.The incident reflects the different epidemiological model from the past.
Objective. To describe the general characteristics and the clinical features of the children GBS in this regional outbreak incident , and compare with dissemination of GBS in the same year, in order to sum up the epidemiological characteristics and discuss the main risk factors of this incident .
Methods. To review and analyze the data of each patient which are obtained concerning age, sex, antecedent events, first symptom, motor symptoms, sensory symptoms, cranial nerve involvement, tendon reflexes, respiratory muscle involvement, the time of onset ,peak and hospitalization, accessory examination results,etc. All calculations were performed using Excel 2003 and SPSS 14.0.Enumeration data were described with number or percentage.t test was applied to compare the difference of enumeration data between groups,while chi square test was applied to compare the difference of measurement data .
Results.①general characteristics: The onset date is between June 21, 2007 to July 6, 2007 .Patients live concentratively in the junction of urban and rural areas in the southwest of Shuangyang.The incidence rate is 8.76 per 100,000 inhabitants.10～20-year-old group has the highest incidence rate and the largest number of cases. There are more male than female.There are significant differences between the incidence rate of male and female (P <0.01). Compared with the control group ,the differences between the digestive tract infection and drinking raw water was significant (P <0.05). The main first symptom is paralysis of limbs.All the patients were accompanied by weakening or disappearance of tendon reflexes. The main subjective sensory symptoms are anaesthesia and pain of limbs, while the main objective sensory symptoms are the obstacles of the peripheral sense (feeling diminish or hypersensitivity). Cranial nerve was often involved in,expecially glossopharyngeal nerve and the vagus nerve,which were followed by the facial nerve. Protein-cell seperation phenomenon were present in 12 cases (50%) while 24 cases recieved cerebrospinal fluid examination.30 cases of patients recieved EMG, 26 cases (86.7%) suggested neurogenic damage, 21 cases for axonal degeneration, 5 cases for demyelination and axonal degeneration.For 75.8 percent (25 cases) of patients,the time from onset to the peak is within one week, the average time is 6.2 days. For all patients the peak sustained time is within one week, the average time is 2.3 days. There were not significant differences between groups for those items above(P> 0.05).②the clinical characteristics of children GBS: The first case of children GBS from Shuangyang district was hospitalized in June 26, 2007. Until July 8, a total of eight were hospitalized, of which five were boys and three girls, aged 6 to 14-year-old, the median age is 10-year-old. There were no significant differences between the items of GBS children with various clinical manifestations and clinical course (P> 0.05).
Conclusions . 1 . The epidemiological characteristics of GBS in Shuangyang region:it is a regional outbreak whose onset date is between June 21, 2007 to July 6, 2007 .Patients were suffering from fowl and live concentratively in the junction of urban and rural areas in the southwest of Shuangyang, The incidence rate is 8.76 per 100,000 inhabitants.There are more male than female.10～20-year-old group has the peak incidence rate.There is no affected patients between 0～5 years old children. 2.The occurrance of the incident was related to the rare high-temperature and dry weather, not excluding the possibility of pollution of water sources.The pathogen still can not be sure entirely, which is presumably Campylobacter jejuni. 3.There is no difference between the clinical features of GBS in Shuangyang and sporadic case, including adults and children.
Guillain-Barrésyndrome is reported as la paralysie aschandante aigue by French academician Landry in 1859 at the very beginning. Following lots of researches,it is founded that GBS is disorders of peripheral nerves mediated by immune. The main pathological changes to peripheral nerve cells was the infiltration of lymphocyte and megaphocyte,while to nerve fibers was segmental demyelination and axonal degeneration. Nearly a century's time, the large number of domestic and foreign scholars study heavily and deeply on the aspects of epidemiology, pathological changes, etiology, pathogenesis, clinical characteristics, treatment of GBS. GBS was broken out between mid-June,2007 and July in Shuangyang district of Changchun City,Jilin Province.The incident reflects the different epidemiological model from the past.
Objective. To describe the general characteristics and the clinical features of the children GBS in this regional outbreak incident , and compare with dissemination of GBS in the same year, in order to sum up the epidemiological characteristics and discuss the main risk factors of this incident .
Methods. To review and analyze the data of each patient which are obtained concerning age, sex, antecedent events, first symptom, motor symptoms, sensory symptoms, cranial nerve involvement, tendon reflexes, respiratory muscle involvement, the time of onset ,peak and hospitalization, accessory examination results,etc. All calculations were performed using Excel 2003 and SPSS 14.0.Enumeration data were described with number or percentage.t test was applied to compare the difference of enumeration data between groups,while chi square test was applied to compare the difference of measurement data .
Results.①general characteristics: The onset date is between June 21, 2007 to July 6, 2007 .Patients live concentratively in the junction of urban and rural areas in the southwest of Shuangyang.The incidence rate is 8.76 per 100,000 inhabitants.10～20-year-old group has the highest incidence rate and the largest number of cases. There are more male than female.There are significant differences between the incidence rate of male and female (P <0.01). Compared with the control group ,the differences between the digestive tract infection and drinking raw water was significant (P <0.05). The main first symptom is paralysis of limbs.All the patients were accompanied by weakening or disappearance of tendon reflexes. The main subjective sensory symptoms are anaesthesia and pain of limbs, while the main objective sensory symptoms are the obstacles of the peripheral sense (feeling diminish or hypersensitivity). Cranial nerve was often involved in,expecially glossopharyngeal nerve and the vagus nerve,which were followed by the facial nerve. Protein-cell seperation phenomenon were present in 12 cases (50%) while 24 cases recieved cerebrospinal fluid examination.30 cases of patients recieved EMG, 26 cases (86.7%) suggested neurogenic damage, 21 cases for axonal degeneration, 5 cases for demyelination and axonal degeneration.For 75.8 percent (25 cases) of patients,the time from onset to the peak is within one week, the average time is 6.2 days. For all patients the peak sustained time is within one week, the average time is 2.3 days. There were not significant differences between groups for those items above(P> 0.05).②the clinical characteristics of children GBS: The first case of children GBS from Shuangyang district was hospitalized in June 26, 2007. Until July 8, a total of eight were hospitalized, of which five were boys and three girls, aged 6 to 14-year-old, the median age is 10-year-old. There were no significant differences between the items of GBS children with various clinical manifestations and clinical course (P> 0.05).
Conclusions . 1 . The epidemiological characteristics of GBS in Shuangyang region:it is a regional outbreak whose onset date is between June 21, 2007 to July 6, 2007 .Patients were suffering from fowl and live concentratively in the junction of urban and rural areas in the southwest of Shuangyang, The incidence rate is 8.76 per 100,000 inhabitants.There are more male than female.10～20-year-old group has the peak incidence rate.There is no affected patients between 0～5 years old children. 2.The occurrance of the incident was related to the rare high-temperature and dry weather, not excluding the possibility of pollution of water sources.The pathogen still can not be sure entirely, which is presumably Campylobacter jejuni. 3.There is no difference between the clinical features of GBS in Shuangyang and sporadic case, including adults and children.
引文
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