神经电生理检查对吉兰-巴雷综合征患儿临床严重度和预后的判断价值  

Value of neuroelectrophysiological examination for judgment of clinical severity and prognosis of children with Guillain-Barre syndrome

作　　者：乔凌燕[1] 孙裕平[1] 于洪波[1] 李德华[1] 杨柳[1] 吕娟[1] 马少春[1] 樊兆民[2] 

机构地区：[1]青岛大学附属青岛市妇女儿童医院神经内科,山东青岛266000 [2]山东大学附属省立医院神经内科,山东济南250021

出　　处：《中国临床研究》2016年第10期1333-1335,共3页Chinese Journal of Clinical Research

基　　金：国家自然科学基金(81170907)

摘　　要：目的研究神经电生理检查在吉兰-巴雷综合征(GBS)患儿临床严重度和预后判断中的应用及其价值。方法 2012年2月至2016年2月共有122例患儿被诊断为GBS。根据患儿Hughes评分进行病情等级划分,轻型29例,重型93例。分析两组患儿的临床症状、神经电生理检查的差异及GBS预后与神经电生理之间的关系。结果上呼吸道感染、面瘫、延髓功能障碍、机械通气与自主神经功能障碍,以及前驱感染史及F波异常等发生率在轻型与重型患儿比较,差异无统计学意义(P均>0.05)。轻型患儿腹泻、胸闷发生率及远端复合肌肉的动作电位(d CMAP)波幅异常发生率低于重型患儿,胫神经运动传导速度(MCV)与腓总神经MCV高于重型患儿,最大Hughes评分低于重型患儿,差异均有统计学意义(P<0.05,P<0.01)。预后良好患儿MCV减慢与d CMAP波幅异常发生率均低于预后较差患儿(P均<0.01)。结论神经电生理检查中MCV减慢、d CMAP波幅降低或消失、Hughes评分高等提示GBS病情恢复慢,预后差,有助于GBS病情程度及预后的判断;F波是诊断GBS的敏感指标,但并非是判断预后的良好指标。Objective To investigate the application of neuroelectrophysiological examination in judgment of clinical severity and prognosis of children with Guillain-Barre syndrome（ GBS） and its value. Methods A total of 122 children diagnosed as GBS from February 2012 to February 2016 were selected and divided into mild type group（ n = 29） and severe type group（ n = 93） according to the Hughes scores about severity of the disease. The clinical symptoms and the findings of neuroelectrophysiological examination were compared between two groups,and the relationship between GBS prognosis and neuroelectrophysiology was analyzed. Results There were no significant differences in the incidences of upper respiratory tract infection,facial paralysis,medulla dysfunction,mechanical ventilation,autonomic nerve dysfunction,history of prodromal infection and F wave abnormity between two groups（ all P〈0. 05）. The incidences of diarrhea and chest tightness,the amplitude abnormity of action potential of the distal compound muscle（ d CMAP） and maximum Hughes score in mild type group were all significantly lower than those in severe type group. The tibial nerve motor conduction velocity（ MCV） and common peroneal nerve MCV in mild type group were significantly higher than those in severe type group（ P〈0. 05,P〈0. 01）. The incidences of MCV slowing and the amplitude abnormity of d CMAP in pediatric patients with good prognosis were significantly lower than those in pediatric patients with poor prognosis（ all P〈0. 01）. Conclusions Slowing of MCV,decrease or disappearance of d CMAP amplitude in neuroelectrophysiological examination and high Hughes score prompt the slower illness recovery and the poor prognosis,and are helpful to judge the severity and prognosis of GBS. F wave is a sensitive indicator for the diagnosis of GBS,but not a good indicator for the judgment of prognosis.

关 键 词：神经电生理检查 吉兰-巴雷综合征 严重度 预后 

分 类 号：R745.4[医药卫生—神经病学与精神病学]