吉兰-巴雷综合征患者神经电生理与临床特点分析  

Analysis of neuroelectrophysiological and clinical characteristics in patients with Guillain-Barrésyndrome

作　　者：陈月秋 刘艳艳 尹俊雄[1] 赵晓丽[1] 石静萍[1] CHEN Yueqiu;LIU Yanyan;YIN Junxiong(Department of Neurology,the Affiliated Brain Hospital of Nanjing Medical University,Nanjing(210000),Jiangsu,China)

机构地区：[1]南京医科大学附属脑科医院神经内科,江苏南京210000

出　　处：《癫痫与神经电生理学杂志》2022年第3期158-162,共5页Journal of Epileptology and Electroneurophysiology(China)

基　　金：南京市科委社发医疗卫生一般项目(201803029);南京市卫生科技发展一般课题项目(YKK18114)。

摘　　要：目的分析吉兰-巴雷综合征(GBS)患者的临床及神经电生理特点,探讨神经电生理评分与临床资料的相关性,为GBS患者的治疗和预后评估提供参考。方法回顾性分析南京脑科医院2018年11月至2020年12月诊断为GBS的住院患者49例的资料,分析其神经电生理评分与临床资料的相关性。结果49例GBS患者中感觉纤维受累46例,运动纤维受累40例,F波受累30例,自主神经系统受累42例,轴索受累46例,髓鞘受累44例,多神经(4条或4条以上)未引出肯定波形17例。神经电生理评分低分者22例,高分者27例。39例患者行血神经节苷脂抗体检测,阳性者25例,其中单种抗体阳性者13例,多种抗体阳性者12例;神经电生理评分低分组与高分组2组患者在峰值hughes评分、随访hughes评分及缓解程度方面比较差异有统计学意义(P=0.032、P=0.045及P=0.026);单种抗体阳性及多抗体阳性两组患者在神经电生理评分方面比较差异有统计学意义(P=0.024),而在性别、年龄、运动症状、感觉症状、颅神经症状、脑脊液蛋白定量、神经电生理评分、治疗方案选择、峰值及随访hughes评分以及预后方面差异无统计学意义(P>0.05)。结论神经电生理评分可用于GBS疾病临床严重程度的评估和预测预后;单种抗体阳性较多种抗体阳性可能造成更严重的神经损害。Objective To analyze the clinical and neuroelectrophysiological characteristics of patients with Guillain-Barrésyndrome(GBS)and explore the correlation between neuroelectrophysiological score and clinical data,providing insights into GBS therapy and prognosis of GBS patients.Methods A retrospective analysis was conducted on 49 hospitalized patients diagnosed with GBS in Nanjing Brain Hospital from November 2018 to December 2020.The correlation between neuroelectrophysiological scores and clinical data was analyzed.Results Among the 49 GBS patients,there were 46 patients with sensory fiber damage,40 patients with motor fiber damage,30 patients with abnormal F wave,42 patients with autonomic nervous system damage,46 patients with axonal damage,44 patients with myelin sheath damage and 17 patients with multiple nerves(four or more)without a wave shape.There were 22 GBS patients with low neuroelectrophysiological scores and 27 with high neuroelectrophysiological scores.Among 39 GBS patients examined for serum antibody against gangliosides,25 GBS patients were positive,including 13 GBS patients with a single antibody positive and 12 GBS patients with multiple-antibody positive.There were statistically significant differences in hughes score at the peak,follow-up hughes score and remission degree between low-and high-neuroelectrophysiological score groups(P=0.032,P=0.045,and P=0.026).There was statistically significant difference in electrophysiological score between single antibody positive and multi-antibodies positive groups(P=0.024),but no significant differences in gender,age,motor symptoms,sensory symptoms,cranial nerve symptoms,cerebrospinal fluid protein quantification,electrophysiological scores,treatment options,peak values,and follow-up hughes scores and prognosis(P>0.05).Conclusion Neuroelectrophysiological score can be used to evaluate GBS severity and predict the prognosis of GBS patients.Single antibody positive might cause more serious neurological damage than multiple antibodies positive do.

关 键 词：吉兰-巴雷综合征(GBS) 神经传导 神经电生理 神经电生理评分 预后 神经节苷脂 

分 类 号：R744.5[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]