急性妊娠合并吉兰-巴雷综合征误诊及预后的回顾性研究  

A retrospective study on misdiagnosis and prognosis of acute pregnancy complicating Guillain-Barré syndrome

作　　者：谷亚伟[1] 蔡增静 范宏光[1] 李强[1] 赵岚[1] 梁雪梅[1] 王利军[1] Gu Yawei;Cai Zengjing;Fan Hongguang;Li Qiang;Zhao Lan;Liang Xuemei;Wang Lijun(Department of Neurology of the Tianjin Fourth Central Hospital,Tianjin 300140,China)

机构地区：[1]天津市第四中心医院神经内科,天津300140

出　　处：《中华医学杂志》2019年第17期1332-1335,共4页National Medical Journal of China

摘　　要：目的探讨急性妊娠合并吉兰-巴雷综合征(GBS)的首诊误诊因素、治疗和预后,以提高首诊确诊率。方法回顾性分析2009年1月至2017年10月天津市第四中心医院神经内科和妇产科收治的45例急性妊娠合并GBS的临床资料。将患者分为首诊确诊组和首诊误诊组,GBS临床分型为经典型和变异型,分析首诊误诊因素。患者均接受静脉注射免疫球蛋白(IVIG)治疗,对比分析治疗效果和预后。结果首诊确诊组20例,首诊误诊组25例,经典型GBS 35例,变异型GBS 10例,患者基线资料差异无统计学意义(P>0.05)。首诊误诊因素分别为医师因素、患方因素、疾病本身因素和实验室因素。变异型GBS较经典型GBS容易引发首诊误诊。首诊确诊组的治疗效果优于首诊误诊组(P<0.05)。首诊误诊组死亡3例,余妊娠患者正常分娩,随访患者无复发、婴儿无先天畸形。结论妊娠是GBS的诱发因素之一。早期确诊和正确治疗可以改善母婴临床结局。Objective To investigate the factors of first misdiagnosis,treatment and prognosis of acute pregnancy complicating with Guillain-Barré syndrome (GBS) in order to improve the first diagnosed rate.Methods A total of 45 acute pregnancy complicating with GBS patients were retrospectively analyzed recruited from January 2009 to October 2017 at the Tianjin Fourth Central Hospital.Patients were divided into the first diagnosis group and the first misdiagnosis group,and GBS clinical types were classified into classic and variant types to analyze the misdiagnosis factors of the first diagnosis.All patients received intravenous immunoglobulin (IVIG) treatment,and the therapeutic effect and prognosis were compared and analyzed.Results There were 20 cases in the first diagnosis group,25 cases in the first misdiagnosis group,35 cases in the typical GBS group,and 10 cases in the variant GBS group.There was no statistically significant difference in the baseline data of the patients(P>0.05).The misdiagnosis factors are divided into four categories: physician factors,patient factors,disease itself factors and laboratory factors.Variant GBS is more likely to lead to misdiagnosis in the first diagnosis than typical GBS.The therapeutic effect of the first diagnosis group was better than that of the first misdiagnosis group(P<0.05).Three patients died in the first misdiagnosis group,and the rest of the pregnant patients gave birth normally,and the babies were born without congenital malformation.Conclusions Pregnancy is one of the inducing factors of GBS.Early diagnosis and correct treatment can improve maternal and infant clinical outcomes.

关 键 词：妊娠 吉兰-巴雷综合征 误诊 预后 

分 类 号：R714.25[医药卫生—妇产科学] R745.43[医药卫生—临床医学]