Guillain-Barré综合征患者临床及脑脊液细胞学特点  

Clinical and cytological characteristics of cerebrospinal fluid in Guillain-Barré syndrome patients

作　　者：李淑敏[1] 王梓涵[1] 彭道勇[1] 孙巧凤[1] 赵红玲[1] 刘赞华[1] 李深[1] 王翠[1] 王苏平[1] 

机构地区：[1]大连医科大学附属大连市中心医院神经内一科,116033

出　　处：《临床神经病学杂志》2015年第1期58-60,共3页Journal of Clinical Neurology

摘　　要：目的探讨Guillain-Barré综合征(GBS)患者临床及CSF细胞学特点。方法回顾性分析37例GBS患者的临床资料。结果本组患者急性起病33例,亚急性起病4例。临床表现为四肢无力18例(48.6%),双下肢无力16例(43.2%),四肢麻木21例(56.8%),双侧面神经麻痹12例(32.4%),其他颅神经损害5例(13.5%),呼吸肌麻痹3例(8.1%),全自主神经功能障碍及Fisher综合征各1例(5.4%);变异型GBS 6例(16.2%)。腰穿CSF检查示4例(10.8%)患者压力高,11例(29.7%)细胞计数升高,29例(78.4%)蛋白升高,7例(18.9%)免疫球蛋白升高。34例(91.9%)CSF细胞学检查异常,22例(64.7%)患者表现为激活的淋巴细胞反应,12例(35.3%)以激活的单核细胞反应为主。感觉或运动神经传导异常25例(67.6%),F波或H反射异常33例(89.2%)。32例患者给予丙种球蛋白或血浆置换治疗,5例给予糖皮质激素治疗,均有效。结论 GBS多数表现为四肢对称性麻木、无力,部分为变异型。F波、H反射电生理检查早期异常率高。CSF细胞学检查早期以淋巴细胞反应为主,后期以单核细胞反应为主。Objective To observe the clinical and cytological characteristics of CSF in Guillain-Barré syndrome（ GBS） patients. Methods The clinical data of 37 GBS patients were retrospectively analyzed. Results Thirty-three cases were acute onset,while 4 cases were subacute onset. Clinical manifestation were limb weakness in 18 cases（ 48. 6%）,bilateral hinder limb weakness in 16 cases（ 43. 2%）,four limb numbness in 21 cases（ 56. 8%）,bilateral facial nerve palsy in 12 cases（ 32. 4%）,other cranial nerve injuries in 5 cases（ 13. 5%）,respiratory muscle paralysis in 3 cases（ 8. 1%）,and autonomic nerve dysfunction and Fisher syndrome in 1 cases（ 5. 4%）respectively; 6 cases（ 16. 2%） were variant GBS. CSF detection demonstrated high intracranial pressure in 4 cases（ 10. 8%）,cell count increase in 11 cases（ 29. 7%）,protein increase was in 29 cases（ 78. 4%）,and immunoglobin increase in 7 cases（ 18. 9%）. Thirty-four patients（ 91. 9%） were confirmed with abnormal CSF cytological detection,within which 22 showed activated lymphocyte（ 64. 7%） and the other 12 showed activated monocyte（ 35. 3%）. Twenty-five cases（ 67. 6%） had abnormal sensory or motor nerve transduction,and 33 cases（ 89. 2%） had abnormal F wave or H reflex. Introvenous immune globulin or plasma replacement was given to 32 patients,and steroids were given to 5 patients,which were both effective. Conclusions Clinical manifestations of GBS are mostly four limb weakness or numbness,and few of them is variant type. Abnormal F wave and H reflex are frequent in early stage of disease. CSF cytological detection confirmed lymphocyte activation in the early phase and monocyte activation in the later phase of GBS.

关 键 词：GUILLAIN-BARRÉ综合征 临床特点 细胞学特点 

分 类 号：R745.4[医药卫生—神经病学与精神病学]