重症吉兰-巴雷综合征患者远期预后评估及相关因素分析  

Long-term prognosis evaluation and related factors analysis of patients with severe Guillain-Barrésyndrome

作　　者：黄培培[1] 苗旺[1] 王亚婷 高林[1] 张齐[1] 何霞[1] 滕军放[1] HUANG Peipei;MIAO Wang;WANG Yating;GAO Lin;ZHANG Qi;HE Xia;TENG Junfang(The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院,河南郑州450052

出　　处：《中国实用神经疾病杂志》2023年第11期1331-1337,共7页Chinese Journal of Practical Nervous Diseases

基　　金：河南省高等学校重点科研项目(编号:23A320022);郑州大学2022年度“四新”教学改革研究与实践项目(编号:2022zzusx021)。

摘　　要：目的评估重症吉兰-巴雷综合征(GBS)患者远期运动功能、日常生活、回归社会状况,分析影响预后的相关性因素,并建立预后不良风险预测模型,为预测重症GBS远期预后提供参考。方法回顾性分析2014-01—2021-08郑州大学第一附属医院神经重症病区收治的93例重症GBS患者临床资料;至2022-08成功随访85例,分别于出院后3个月、6个月、1 a进行Hughes评分,对生活质量进行Barthel指数评定量表(BI)评分,并对社会功能恢复及自身感受情况评估。以随访1 a时Hughes评分进行分组,分为预后良好组69例(Hughes评分0~2分),预后不良组16例(Hughes评分3~6分),2组间进行单因素和多因素Logistic回归分析,建立预后不良列线图预测模型并进行内部验证,通过绘制校准曲线、决策曲线来评估预后不良预测模型对患者预后不良的预测价值。并对患者恢复独立行走所需时间相关因素进行K-M生存曲线分析。结果(1)入住神经ICU患者有感染诱因者占57.0%,合并基础疾病者占53.8%,入住原因82.8%和呼吸系统风险有关;67.7%患者应用呼吸机,44.4%患者辅助通气时长超过2周;主要治疗方案中,单纯免疫球蛋白治疗占63.4%,24.7%患者应用免疫球蛋白联合其他治疗。(2)重症GBS患者1 a病死率为10.5%,致残率为8.2%。与预后良好组相比,预后不良组患者年龄较大、起病急、病情进展快、瘫痪程度重。其中年龄、发病至ICU时间是重症GBS患者预后不良的相关因素。(3)建立2个因素风险预测模型,并以列线图展示,重症GBS患者预后的校准曲线表明,预测模型与理想模型间具有良好的一致性。决策曲线显示预测模型具有良好的临床应用价值。(4)K-M生存曲线分析表明,年龄与恢复独立行走所需时间无关,恢复行走所需时间与是否机械通气相关,机械通气患者总体需要更长的恢复时间。(5)79.6%的患者日常生活不受影响,48.6%恢复正常工作,10.8%患者存在焦�Objective To evaluate the long-term motor function,daily life and social status of patients with severe Guillain-Barrésyndrome(GBS),analyze the correlation factors affecting the prognosis,and establish a risk prediction model for poor prognosis,so as to provide reference for predicting the long-term prognosis of severe GBS.Methods The clinical data of 93 patients with severe GBS admitted to the Neurological Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University from January 2014 to August 2021 were retrospectively analyzed.Eighty-five patients were followed up successfully in August 2022.Hughes score,Barthel index score,social function recovery and self-perception were evaluated at 3 months,6 months and 1 year after discharge.According to the Hughes score at 1-year follow-up,69 patients were divided into good prognosis group(Hughes score 0-2)and 16 patients were divided into poor prognosis group(Hughes score 3-6).Univariate and multivariate Logistic regression analysis were performed between the two groups to establish a nomogram prediction model for poor prognosis and internal verification was performed.Calibration curve and decision curve were drawn to evaluate the predictive value of poor prognosis prediction model for poor prognosis of patients.The K-M survival curve was used to analyze the factors related to the time required for the recovery of independent walking.Results(1)57.0%of the patients admitted to Neurological ICU had infection inducement,53.8%had underlying diseases,and 82.8%of the reasons were related to respiratory risk;67.7%of the patients used ventilators,and 44.4%of the patients used ventilator-assisted ventilation more than 2 weeks.Among the main treatment options,63.4%of patients received immunoglobulin alone and 24.7%received immunoglobulin combined with other treatments.(2)The 1-year mortality rate and disability rate of severe GBS patients were 10.5%and 8.2%,respectively.The poor prognosis group had older age,rapid onset,rapid disease progression,and severe paralys

关 键 词：重症吉兰-巴雷综合征 预后 运动功能 社会功能 年龄 机械通气 

分 类 号：R745.43[医药卫生—神经病学与精神病学]