吉兰-巴雷综合征患儿神经电生理分析及临床预后评估  

Electrophysiological Analysis and Prognosis Assessment of Guillain-Barré Syndrome in Children

作　　者：虞雄鹰[1] 钟建民[1] 吴华平[1] 陈勇[1] 杨萌[1] 王倩[1] 李建华[1] 蔡兰云[1] 

机构地区：[1]江西省儿童医院神经内科,南昌330006

出　　处：《实用儿科临床杂志》2010年第16期1261-1263,共3页Journal of Applied Clinical Pediatrics

基　　金：江西省卫生厅课题(20071136)

摘　　要：目的探讨神经电生理检查对吉兰-巴雷综合征(GBS)患儿临床严重度和预后的判断价值。方法回顾性分析37例GBS患儿的临床表现和神经电生理结果及预后,分析不同时期Hughes评分和神经电生理异常与GBS临床预后的关系。结果 37例GBS儿童中27例痊愈(占72.97%),3例基本恢复(占8.11%),4例部分恢复(占10.81%),2例预后差(占5.41%),1例死亡(占2.70%);根据预后分为预后差、部分恢复、基本恢复和痊愈,其高峰期日平均Hughes评分分别为(5.00±0.00)分、(4.25±0.96)分、(4.33±0.58)分、(3.93±0.92)分;进展期Hughes总评分分别为(59.00±14.14)分、(38.25±10.97)分、(26.67±6.03)分、(19.74±4.24)分。起病1周内、2～4周、3～6个月进行3次神经电生理检查,3次神经传导速度(NCV)检查的总异常率分别为78.4%、80.6%、77.8%,NCV异常率比较差异无统计学意义(χ2=2.161,P=0.904)。根据神经电生理诊断特征可分为3种类型,其中脱髓鞘型在3次神经电生理检查中分别为40.5%、30.6%、35.1%,轴索损害型分别为13.5%、22.2%、22.2%,混合型则分别为24.3%、27.8%、19.4%,3次检查中不同预后组神经电生理诊断分型比较差异无统计学意义。结论儿童GBS患者普遍预后良好,疾病早期临床严重程度、电生理异常率与临床预后无明显相关性,但进展期总Hughes评分具有一定的预后评估价值。Objective To investigate the prognosis of Guillain-Barré syndrome（GBS） in children,and the evaluation of clinical severity and prognosis of GBS in children according to neurological electrophysiology.Methods The relationship of clinical and electrophysiological features to outcome and the relationship of Hughes scores and electrophysiological features in the various stages to prognoses in 37 children with GBS were retrospectively analyzed.Results Among 37 children with GBS,27 cases （72.97%）were full recovery,3 cases （8.11%） were basic recovery,4 cases（10.81%） were partial recovery,2 cases（5.41%） were bad prognosis,1 case（2.70%） died.The peak daily Hughes scores were 5.00±0.00,4.25±0.96,4.33±0.58,3.93±0.92,respectively in bad prognosis group,partial recovery group,basic recovery group and full recovery group; and the whole Hughes scores in progressive stage were 59.00±14.14,38.25±10.97,26.67±6.03 and 19.74±4.24,respectively.The examinations of neurological electrophysiology were performed in GBS cases during first week,2-4 weeks and 3-6 months after onset.The whole abnormal rates of nerve conduction velocity（NCV） were 78.4%,80.6% and 77.8% in the above 3 tests（χ^2=2.161,P=0.904）.The cases were classified based on the electrodiagnostic features in 3 electrophysiological examinations： the demyelinating forms of GBS accounted for 40.5%,30.6% and 35.1%;the axonal forms made up 13.5%,22.2% and 22.2%;mixed forms occupied 24.3%,27.8% and 19.4%,respectively.There was no significant difference in the electrodiagnostic classificatin among 3 electrophysiological tests in different prognosis groups.Conclusions In general,the prognosis of GBS in children was good.It seems that clinical severity and abnormal electrophysiology in the early stage don′t relate to the outcomes of GBS in children.However,Hughes scores in progressive stage might predict their prognosis.

关 键 词：吉兰-巴雷综合征 神经电生理 Hughes评分 儿童 

分 类 号：R745.43[医药卫生—神经病学与精神病学]