吉兰-巴雷综合征治疗相关症状波动11例临床分析  

Clinical features of Guillain-Barré syndrome with treatment related fluctuations

作　　者：胡珏[1] 黎园[1] 徐伟[1] 童洋萍[1] 赵志鸿[2] HU Jue;LI Yuan;XU Wei(Department of Neurology,Changsha Centre Hospital,Changsha 410004,China)

机构地区：[1]长沙市中心医院神经内科,湖南长沙410004 [2]湖南省人民医院神经内科,湖南长沙410002

出　　处：《中风与神经疾病杂志》2018年第5期450-452,共3页Journal of Apoplexy and Nervous Diseases

基　　金：湖南省卫生计生委2018年度科研计划课题项目(B20180797);2017年度湖南省临床医疗技术创新引导计划项目(序号99);长沙市中心医院科研立项项目(YNKY201801)

摘　　要：目的探讨吉兰-巴雷综合征伴治疗相关症状波动(Guillain-Barré syndrome with treatment related fluctuations,GBS-TRF)患者的临床特征及预后。方法报道1例GBS-TRF;检索Pubmed数据库中GBS-TRF的相关文献,收集临床资料较为详实的10例GBS-TRF;对11例GBS-TRF的临床资料、治疗及转归进行回顾性分析。结果病程中最低点MRC评分为(33.8±14.4)、F评分为(4.2±0.8);首次免疫治疗后最佳MRC评分为(46.5±10.5)、F评分(3.5±1.1);治疗相关症状波动后最低MRC评分为(37.0±11.7)、F评分为(4.0±0.9)。11例均发生1次GBS-TRF,在首次免疫治疗后10~60(24.5±14.4)d出现。7例接受再次免疫治疗,4例治疗后改善,3例治疗后病情稳定;4例未接受再次免疫治疗。住院后6 m MRC评分为(54.5±7.8)、F评分为(1.5±1.4)。11例随访均无复发。结论 GBS患者可在免疫治疗后数天至8 w内出现GBS-TRF,治疗相关症状波动时临床功能评分通常优于病程中最低点评分;重复免疫治疗可能缩短病程;多数患者预后较好。Objective To investigate the clinical features of Guillain -Barré syndrome with treatment related fluctuations（GBS-TRF）. Methods One GBS-TRF patient admitted to our department was reported and 10 GBS-TRF cases with detailed clinical data searched from Pubmed database were included. The clinical data,treatment and outcome of the 11 cases were retrospectively analyzed. Results The nadir MRC score was （33.8 ± 14.4） and the nadir F score was （4.2 ± 0.8）. After the first immunotherapy,the best MRC score was （46.5 ±10.5）and best F score was（3.5±1.1.After TRF,the lowest MRC score was （37.0±11.7）and the lowest F score was（4.0 ±0.9.TRF occurred one time in every patient. TRF occurred within 10～60（24.5±14.4）days after the first immunotherapy. 7 cases received the second immunotherapy. 4 cases improved and 3 cases were stable after the second treatment. 4 cases did not receive a second immunotherapy. Six months after admission,The MRC score was （54.5±7.8） and F score was （1.5±1.4）. No further replases ocuured during the follows up. Conclusions GBS patients may develop GBS-TRF within days to 8 weeks after immunotherapy. After TRF,the lowest MRC score and F score are usually better than the scores of nadir. Repeated immunotherapy may shorten the course of the disease. Most GBS-TRF patients have good prognosis.

关 键 词：吉兰-巴雷综合征 治疗相关症状波动 免疫治疗 

分 类 号：R745[医药卫生—神经病学与精神病学]