吉兰-巴雷综合征患者血-脑脊液屏障损伤与24小时鞘内免疫球蛋白G合成率的关系及其临床意义  

Relationship Between the Damage of Blood- brain Barrier and 24 Hour Intrathecal Ig G Synthesis Rate of Patients With Guillain-Barré Syndrome and Its Clinical Significance

作　　者：傅珏[1] 周月平[2] 余莎莎[1] 朱德生[3] 

机构地区：[1]南昌大学抚州医学院病理教研室,江西省抚州市344000 [2]南昌大学第五附属医院细胞室 [3]复旦大学附属华山医院神经内科

出　　处：《中国全科医学》2016年第14期1638-1641,共4页Chinese General Practice

基　　金：中国博士后基金面上项目(2014M560297);江西省卫生厅科技计划项目(20112025);南昌大学抚州医学院科技重点课题(CDFY-KJ1504)

摘　　要：目的探讨吉兰-巴雷综合征(GBS)患者血-脑脊液屏障损伤与24 h鞘内免疫球蛋白G(IgG)合成率的关系及其临床意义。方法选取2010年1月—2015年6月南昌大学第五附属医院神经内科住院经腰椎穿刺免疫学检查与肌电图检查确诊的GBS患者69例,回顾性收集其临床资料。根据24 h鞘内IgG合成率将患者分为中枢神经系统免疫正常组与偏高组,并比较两组患者临床、生化特征;根据脑脊液清蛋白/血清清蛋白(QALB)将患者分为血-脑脊液屏障正常组、轻度损伤组、中度以上损伤组,并观察3组间24 h鞘内IgG合成率的变化;分析QALB与24 h鞘内IgG合成率的相关性。结果 GBS患者根据24 h鞘内IgG合成率分为正常组34例,偏高组35例。两组性别、年龄、残疾量表评分、颅神经症状、自主神经症状、麻木症状、肺部感染发生率比较,差异均无统计学意义(P>0.05)。偏高组QALB、脑脊液清蛋白、脑脊液IgG、脑脊液IgG指数均高于正常组(P<0.01)。GBS患者根据QALB分为血-脑脊液屏障正常组20例、轻度损伤组26例及中度以上损伤组23例。3组24 h鞘内IgG合成率比较,差异有统计学意义(P<0.01);其中中度以上损伤组24 h鞘内IgG合成率高于血-脑脊液屏障正常组(F=6.20,P<0.01)。Spearman相关分析结果显示,QALB与24 h鞘内IgG合成率呈正相关(rs=0.66,P<0.01)。结论 24 h鞘内IgG合成率随血-脑脊液屏障损伤而增加,QALB与24 h鞘内IgG合成率有助于GBS的病情监测及预后评估。Objective To explore the relationship between the damage of blood-brain barrier（ BBB） and 24 hour intrathecal Ig G synthesis rate of patients with Guillain- Barré syndrome（ GBS） and its clinical significance. Methods A total of 69 patients who were diagnosed with GBS by immunologic test through lumbar puncture and electromyogram examination and hospitalized in the Department of Pathology of the Fifth Affiliated Hospital of Nanchang University from January 2010 to June 2015 were enrolled and their clinical data was collected retrospectively. The patients were divided into normal central nervous system immunity group（ normal group） and slightly higher central nervous system immunity group（ slightly higher group） according to 24 hour intrathecal Ig G synthesis rate,and comparison was made between the two groups in clinical and biochemical features.The patients were divided into normal BBB group,mild damage group and moderate above damage group according to the ratio of cerebrospinal fluid albumin to serum albumin（ QALB）,and the changes of 24 hour intrathecal Ig G synthesis rate of the three groups were observed. The correlation between QALB and 24 hour intrathecal Ig G synthesis rate was analyzed. Results The patients with GBS were divided into the normal group（ n = 34） and slightly higher group（ n = 35） according to 24 hour intrathecal Ig G synthesis rate. The differences of gender,age,the scores of Hughes Scale,the symptom of cranial nerve,the symptoms of autonomic nerve,the symptom of numbness and the occurrence rate of pulmonary infection between the two groups were not significant（ P 〉 0. 05）. Slightly higher group was higher than normal group in QALB,CSF protein,CSF Ig G and the index of CSF Ig G（ P 〈 0. 01）. The patients were divided into normal BBB group（ n = 20）,mild damage group（ n = 26） and moderate above damage group（ n = 23） according to QALB; the differences of 24 hour intrathecal Ig G synthesis rate among the three groups were significantly differen

关 键 词：格林-巴利综合征 血脑屏障 QALB 24 h鞘内IgG合成率 

分 类 号：R745.44[医药卫生—神经病学与精神病学]