创伤/手术后吉兰-巴雷综合征临床特点及短期预后分析  

Clinical Characteristics and Short-term Prognosis of Guillain-BarréSyndrome following Trau⁃ma or Surgery

作　　者：蔡嘉琳 李志军 唐娜 聂青 付佩彩 CHOI Ka-lam;LI Zhi-jun;TANG Na;NIE Qing;FU Pei-cai(Department of Neurology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经内科,武汉430030

出　　处：《神经损伤与功能重建》2023年第6期316-319,324,共5页Neural Injury and Functional Reconstruction

基　　金：湖北省自然科学基金项目(No.2022C FB726);湖北省卫生健康委员会科研项目(No.WJ2021M119)。

摘　　要：目的:分析创伤/手术后吉兰-巴雷综合征(GBS)患者的临床特点以及短期预后的影响因素。方法:搜集2016年1月至2022年6月在同济医院神经内科就诊的创伤/手术后GBS患者25例的临床资料和血清炎性标志物,分析短期预后影响的因素。结果:25例创伤/手术后GBS患者中,男21例,女4例;平均年龄(49.6±12.6)岁;发病季节以夏秋季节为主。从创伤/手术到GBS症状的平均间隔为(11.4±7.2)d,GBS症状达峰时间为(9.6±5.4)d。入院时,Hughes评分为(3.36±1.31)分,MRC总分评分为(30.56±16.78)分。28%的患者进入ICU治疗,24%患者呼吸肌无力/需要呼吸支持。17例(68%)患者接受了静脉免疫球蛋白治疗,3例(12%)患者接受血浆置换。3例(12%)患者在住院期间死亡。平均住院时间为(22.7±11.6)d。根据出院时的Hughes评分将患者分为短期预后较差组(Hughes评分≥3分)14例和短期预后较好组(Hughes评分<3分)11例,比较2组的临床数据可得:短期预后较差组患者年龄更大(P=0.002)、入院时Hughes评分以及MRC总分评分更低(P<0.001)、进入ICU比例更高(P=0.021)、需要呼吸支持的患者比例更多(P=0.043),出院时Hughes评分及MRC总分评分显著低于预后较好组(均P<0.001);血清标志物血清中中性粒细胞计数/淋巴细胞计数(NLR)、C反应蛋白/白蛋白(CRP/Alb)水平明显高于预后较好组(P=0.005、0.048),血尿酸水平明显低于较预后较好组(P=0.003);IgG型抗GM1-抗体阳性患者比例高于预后较好组(P=0.010)。多因素回归分析显示,入院时MRC总分评分、NLR为创伤/手术后GBS患者短期内预后不良的危险因素。结论:创伤/手术后GBS患者以重症GBS为主,短期预后差。入院时MRC总分评分、NLR为短期内预后不良的危险因素。Objective:To investigate the clinical characteristics of patients with Guillain-Barrésyndrome(GBS)following trauma or surgery and explore factors influencing short-term prognosis.Methods:Clinical da-ta and serum levels of inflammatory markers were collected from 25 patients with trauma-or surgery-related GBS who were treated at the Department of Neurology of Tongji Hospital from January 2016 to June 2022.The factors influencing short-term prognosis were analyzed.Results:Among the 25 patients with trauma-or sur-geryrelated GBS,21 were males and 4 were females,and the mean age was 49.6±12.6 years.In terms of sea-sons,the onset of symptoms mainly occurred in summer and autumn.The average interval from trauma or sur-gery to onset of GBS symptoms was 11.4±7.2 days,and the interval from onset to peak GBS symptoms was 9.6±5.4 days.On admission,the mean Hughes score was 3.36±1.31,and the total Medical Research Council(MRC)Scale score was 30.56±16.78;28%of the patients were admitted to the intensive care unit(ICU)for further treat-ment,and 24%of the patients had respiratory myasthenia or needed ventilation support for dyspneic respiration.Overall,17 patients(68%)received intravenous immunoglobulin therapy and three(12%)received plasmaphere-sis.Three patients(12%)died during hospitalization.The average length of hospital stay was 22.7±11.6 days.Based on the Hughes score at discharge,patients were assigned to the poor short-term prognosis group(Hughes score≥3)(n=14 patients)or the better short-term prognosis group(Hughes score<3)(n=11 patients).Compared with that noted in the better short-term prognosis group,the clinical characteristics in the poor short-term prog-nosis group were as follows:older patients(P=0.002),lower Hughes score and total MRC score at admission(P<0.001),and higher proportion of patients admitted to the ICU(P=0.021)and requiring ventilation support(P=0.043).Regarding serum inflammatory markers,the serum neutrophil-to-lymphocyte ratio(NLR)and C-reac-tive protein/albumin ratio(CRP/Alb)were signi

关 键 词：吉兰-巴雷综合征 创伤/手术后 血清炎症标志物 中性粒细胞计数/淋巴细胞计数比值 短期预后 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.02[医药卫生—临床医学] R746