对格林-巴利综合征的再认识  

For further understanding of guillain-barre syndrome

作　　者：李杨[1] 郭虎[1] 郑帼[1] 

机构地区：[1]江苏省南京医科大学附属南京儿童医院神经科,210008

出　　处：《中华全科医学》2015年第2期199-201,共3页Chinese Journal of General Practice

摘　　要：目的格林-巴利综合征是儿童时期较常见的周围神经系统疾病之一,早期诊断与治疗有助于疾病恢复,现回顾分析病例与文献,提高对格林-巴利综合征诊断与治疗的认识,以便早期诊断与合理治疗。方法回顾分析2006年1月—2012年6月46例格林-巴利综合征的临床资料、实验室检查、预后资料,根据起病时的主要表现,分为4组,分别为双下肢无力组、共济失调组、外展神经麻痹组、感觉异常组,其中双下肢无力组37例均予以丙种球蛋白治疗[400 mg/(kg·d),5 d为1疗程],共济失调组6例中3例予以丙种球蛋白治疗[400 mg/(kg·d),5 d为1疗程]、3例予以地塞米松治疗[0.25 mg/(kg·d),治疗10 d],外展神经麻痹组2例均予以地塞米松治疗(0.25 mg/(kg·d),治疗10 d],感觉异常组1例予以甲钴胺0.5 mg/(kg·d)和神经节苷脂20 mg/(kg·d)治疗2周,观察治疗效果,并结合国内外报道,探讨对格林-巴利综合征的再认识。结果双下肢无力组以双下肢乏力起病37例,其中35例伴有脑脊液蛋白-细胞分离;共济失调组以共济失调起病6例,指鼻不准、行走不稳,膝腱反射消失;外展神经麻痹组以孤立眼球外展受限起病2例,膝腱反射正常,四肢电生理正常,脑脊液正常;感觉异常组以感觉异常起病1例,双下肢麻木,膝腱反射减弱,电生理示感觉神经损害。结论格林-巴利综合征多以双下肢乏力起病,少数以共济失调、眼球外展受限、感觉异常起病,多伴有脑脊液蛋白-细胞分离、电生理周围神经损害表现,少数脑脊液细胞蛋白正常、电生理检查正常,孤立外展神经麻痹是格林-巴利综合征局部变异型。Objective Guillain-Barre syndrome was one of the more common childhood peripheral nervous system disease,early diagnosis and proper treatment can help disease recovery,now we analyzed cases and reviewed literature,in order to improve the understanding about diagnosis and treatment of Guillain-Barre syndrome（ GBS）. Methods Clinical data,laboratory tests and prognostic information of 46 children with GBS were analyzed retrospectively. According to the onset of the main performance,they were divided into four groups,lower extremity weakness group,ataxia group,abducens nerve palsy group,and paresthesia group,37 cases of lower extremity weakness group were treated with IVIG[400 mg /（ kg·d）,5 days for a course of treatment],3 cases of ataxia group were treated with IVIG[400 mg /（ kg · d）,5 days for a course of treatment],3 cases of ataxia group were treated with dexamethasone[0. 25 mg /（ kg·d）,for 10 days],2 cases of abducens nerve palsy group were treated with dexamethasone（ 0. 25 mg /（ kg·d）,for 10 days）,1 case of paresthesia group was treated with mecobalamin 0. 5 mg /（ kg·d） and ganglioside 20 mg /（ kg·d） for 2 weeks,the treatment effect was observed and combined with the documents concerned,for further understanding of GBS. Results 37 cases were the symmetry lower limbs weakness,and 35 cases with csf protein-cell separation; 6 cases with ataxia and csf protein-cell separation; 2 cases with solitary eye abduction; 1 case with paresthesia. Conclusion GBS usually presented lower limbs weakness,few ataxia,outreach nerve paralysis,paresthesia,many accompanied by cerebrospinal fluid protein-cell separation,electrophysiological characteristics of peripheral nerve damage,a few normal cerebrospinal fluid cell protein,normal electrophysiological examination,isolated abducens nerve palsy was the local variant of GBS.

关 键 词：格林-巴利综合征 共济失调 肌肉麻痹 脑脊液蛋白-细胞分离 

分 类 号：R744.5[医药卫生—神经病学与精神病学]