儿童吉兰-巴雷综合征治疗后初始反应对预后的早期评价价值探讨  

Early Predictive Value of Treatment Response Rate on Prognosis in Children with Guillain-BarréSyndrome

作　　者：靳梅[1,2] 刘静 耿文锦[1] 赵紫薇[1] 孙素真 JIN Mei;LIU Jing;GENG Wen-jin;ZHAO Zi-wei;SUN Su-zhen(The Children Hospital of Hebei Province,Shijiazhuang 050000,China;Key Laboratory of Child Epilepsy and Neurology of Hebei Province,Shijiazhuang 050000,China)

机构地区：[1]河北省儿童医院,石家庄050000 [2]河北省小儿癫间与神经疾病重点实验室,石家庄050000

出　　处：《中国临床神经科学》2023年第1期36-42,共7页Chinese Journal of Clinical Neurosciences

基　　金：河北省省级科技计划资助(编号:22377756D);2023年河北省医学科学研究重点课题计划(编号:20230172)。

摘　　要：目的探讨儿童吉兰-巴雷综合征(GBS)药物治疗后初始反应对预后的预测价值。方法回顾分析2013年6月至2021年5月神经内科收治的65例GBS患儿临床资料。根据静脉注射免疫球蛋白(IVIg)后肢体运动功能评分改善至少>1级的最初反应时间,将患儿分为快反应组(反应时间为7 d内)和慢反应组(反应时间为8~60 d)。分别于入院时、疾病高峰、发病1和6个月时采用Hughes分级量表评估患儿肢体运动功能情况。结果65例GBS患儿,其中男38例、女27例,年龄1~13岁;快反应组42例、慢反应组23例。两组性别、年龄、前驱感染史、起病至入院时间、合并面神经及球麻痹、电生理分型、脑脊液蛋白、抗体检测差异均无统计学意义(均P>0.05)。慢反应组合并自主神经功能障碍及机械通气明显高于快反应组(均P<0.05)。快反应组的发病1及6个月预后良好者均多于慢反应组(均P<0.05)。Kaplan-Meier生存分析曲线得出两组在短期(发病1个月)预后预测方面差异有显著性(log-rank检测,P=0.012)。结论GBS患儿经IVIg治疗后初始反应时间对预后有预测价值,7d内出现治疗反应提示短期预后良好;反之,提示预后不良。Aim To identify the treatment response in relation to the outcomes of Guillain-Barrésyndrome(GBS)and investigate its potential predictive value for prognosis.Methods Our retrospective study included 65 children diagnosed with GBS in the pediatric neurology department from June 2013to May 2021.According to the rate of response from the standard intravenous immunoglobulin(IVIg)treatment,the patients were divided into two groups:a rapid-response GBS(initial response within 7days)and a slow-response(initial response within 8-60 days).Hughes Functional Grading Scale was used to assess the children’s functional disability at admission,nadir,1 month,and 6 months after onset.Results Among the 65 children included in the study,42(64.6%)and 23(35.4%)were rapid and slow responders,respectively.There were no signi?cant differences in gender,age,preceding infection,time from onset to admission,facial nerve and bulbar palsy,electrophysiological subtypes,cerebrospinal?uid protein and antibody detection between the two groups(P>0.05).In terms of autonomic dysfunction and mechanical ventilation,the slow-response GBS were significantly higher than the rapid-response GBS(P<0.05).The number of cases with good prognosis in rapid-response GBS was more than that in slow-response GBS at 1 month and 6 months(P<0.05).Survival analysis(Kaplan-Meier)with respect to regaining the ability to walk independently(Hughes Functional Grading Scale of 2)within1 month after onset was signi?cantly different among the two groups(log-rank test for trend,P=0.012).Conclusion The rate of response to IVIg treatment was correlated with outcomes in children with GBS and had predictive value for prognosis.Patients whose response time was within 7 days had a good shortterm outcome,vice versa.

关 键 词：吉兰-巴雷综合征 儿童 治疗初始反应 Hughes功能评分 短程及长程预后 

分 类 号：R745[医药卫生—神经病学与精神病学]