Guillain-Barré综合征患者脑脊液蛋白水平与疾病严重性及预后的关系  

Association of protein levels in cerebrospinal fluid with the disease severity and prognosis of patients with Guillain-Barré syndrome

作　　者：王胜会 张丽丽[2] 乔保俊 李会会 王玉忠[2] 郝延磊[2] WANG Sheng-hui;ZHANG Li-li;QIAO Bao-jun(Graduate School of Shandong University,Jinan 250100,China)

机构地区：[1]山东大学研究生院,济南250100 [2]济宁医学院附属医院神经内科

出　　处：《临床神经病学杂志》2019年第3期171-175,共5页Journal of Clinical Neurology

基　　金：国家自然科学基金资助项目(81771298,81771360)

摘　　要：目的总结Guillain-Barré综合征(GBS)患者CSF蛋白细胞分离现象(AD-CSF)的特点,分析GBS患者CSF蛋白水平与疾病严重性和预后的关系,探讨其临床意义。方法回顾性收集2007年1月至2016年10月在济宁医学院附属医院住院的206例GBS患者的一般临床资料(性别、年龄、前驱感染和电生理分类)、CSF细胞数和蛋白水平、高峰期及12个月后残疾评分(GDS),比较发病后≤7d、8~14d、15~21d、≥22d患者AD-CSF的阳性率。利用Pearson相关及Spearman相关分析电生理正常组、脱髓鞘型组、轴索型组、不能分型组患者CSF蛋白水平与高峰期及12个月后GDS的关系。结果患者发病第3周时腰穿的AD-CSF阳性率最高(85.7%),与其他时间点相比,差异有统计学意义(均P<0.001)。电生理正常组CSF蛋白水平与高峰期GDS呈正相关(r=0.707,P=0.003),与12个月后GDS无相关性;脱髓鞘型组CSF蛋白水平与高峰期及12个月后GDS均呈正相关(r=0.495,P=0.019;r=0.770,P<0.001)。回归分析表明,CSF蛋白水平是脱髓鞘型GBS患者高峰期GDS以及12个月后更高GDS的预测因子。结论GBS患者AD-CSF的阳性率与腰穿的时间密切相关;CSF蛋白水平可作为脱髓鞘型GBS高峰期疾病更重以及预后不良的预测因子。Objective To summarize the characteristics of the albuminocytologic dissociation in CSF( AD-CSF) from patients with Guillain-Barré syndrome ( GBS),and to analyze the relationship between protein levels in CSF and disease severity as well as prognosis in patients with GBS to explore its clinical significance.Methods Two hundred and six of patients fulfilled with GBS from Affiliated Hospital of Jining Medical College between January 2007 and October 2016 were retrospectively included.The general clinical data ( sex, age, antecedent infection and electrophysiological classification),cell number and protein levels in CSF,GBS disability score ( GDS) at nadir and after 12 months were collected.The positive rate of AD-CSF in patients who underwent lumbar puncture within ≤7 d,8 - 14 d,15 - 21 d,≥22 d after onset were compared.Pearson correlation and Spearman correlation were used to analyze the relationship between protein levels in CSF and GDS at nadir and after 12 months in electrophysiological normal group,demyelinating group,axonal group and unclassified group.Results At the third week after onset,the positive rate of AD-CSF was the highest ( 85.7%),when compared with other time points,the difference was statistically significant ( all P < 0. 001).In electrophysiological normal group,CSF protein levels were positively correlated with GDS at nadir ( r = 0. 707,P = 0. 003),no correlation with GDS after 12 months;in demyelinating group,CSF protein levels were positively correlated with GDS at nadir and after 12 months ( r = 0. 495,P = 0. 019;r = 0. 770,P < 0. 001).Regression analysis showed that CSF protein levels were predictors of GDS at nadir and 12 months in patients with demyelinating GBS.Conclusion The frequency of AD-CSF in GBS patients is closely related to the time piont of lumbar puncture;CSF protein level can be used as a predictor of more severity at nadir and poor prognosis for patients with demyelinating GBS.

关 键 词：GUILLAIN-BARRÉ综合征 CSF蛋白-细胞分离 疾病严重性 电生理分类 

分 类 号：R744.5[医药卫生—神经病学与精神病学]