吉兰-巴雷综合征患者血脑屏障通透性与临床预后的相关性  

Correlation between blood-brain barrier permeability and clinical prognosis in patients with Guil-lain-Barre syndrome

作　　者：李梅[1] 于鹭 韩露[1] 杨红[1] 朱德生[2] 管阳太[1,2] 

机构地区：[1]第二军医大学附属长海医院神经内科,200433 [2]上海交通大学医学院附属仁济医院神经内科

出　　处：《神经疾病与精神卫生》2017年第4期248-251,共4页Journal of Neuroscience and Mental Health

基　　金：国家自然科学基金重点项目（81230027）;上海市卫计委面上项目（201440347）

摘　　要：目的 探讨吉兰-巴雷综合征（GBS）患者血脑屏障通透性与临床预后的相关性及临床意义.方法 随访2013年1月~2016年6月第二军医大学附属长海医院收治的78例GBS患者,根据出院后第6个月时Hughes评分分为预后较好组（Hughes＜3分）和预后不良组（Hughes≥3分）,比较两组间临床、脑脊液生化资料及免疫治疗方式.结果 临床预后较好组与不良组之间患者性别、年龄、发病季节、前驱症状、肺部感染、机械通气、脑脊液蛋白、免疫球蛋白G（IgG）、IgG指数、24 h鞘内IgG合成率、神经轴索损伤、免疫治疗等比较差异均无统计学意义（P＞0.05）,入院时肌力评分、脑脊液白蛋白/血清白蛋白比值比较差异有统计学意义（χ2分别为11.73,8.01;P＜0.05）.血脑屏障损伤与患者临床预后不良呈正相关（r=0.32,P＜0.01）.结论 GBS患者入院时血脑屏障损伤其临床预后较差,血脑屏障通透性可作为评估GBS患者临床预后的生化指标.Objective To explore the correlation between the blood-brain barrier dysfunction and clinical prognosis in patients with Guillain-Barre syndrome （GBS）. Methods Totals of 78 patients with GBS in department of neurology were followed-up from January 2013 to June 2016. All patients were divided into two groups based on Hughes scale at 6 months：the good prognosis group （Hughes 〈 3） and poor prognosis group （Hughes ≥ 3）. Clinical and biochemical data,as well as immunotherapy were analyzed. Results Between the good and poor prognosis groups,there were no significant differences in gender,age,onset season,proceeding infection,pneumonia,mechanical ventilation,cerebrospinal fluid protein,immunoglobulin G,IgG-index, intrathecal IgG synthesis rate within 24 hours,injury of nerve axonal and immunotherapy （P〉0.05）. There were statistically significant differences in score of muscle strength on admission and albumin CSF/serum ratio（QALB） （χ2=11.73,8.01;P〈0.05）. Blood-brain barrier dysfunction was positively correlated with clinical poor prog-nosis （r=0.32,P〈0.01）. Conclusions The blood-brain barrier dysfunction in patients with GBS is associated with poor prognosis. Therefore,blood-brain barrier permeability may be used to predict the prognosis of patient with GBS.

关 键 词：血脑屏障 神经免疫 吉兰-巴雷综合征 临床预后 

分 类 号：R745.43[医药卫生—神经病学与精神病学]