新型冠状病毒感染相关吉兰-巴雷综合征4例  

Four cases of COVID-19 associated Guillain-Barrésyndrome

作　　者：管雅琳[1] 费云瀚 于长申[1] 王盼 吴昊 齐雪梅 王新平[1] 赵文娟[2] Guan Yalin;Fei Yunhan;Yu Changshen;Wang Pan;Wu Hao;Qi Xuemei;Wang Xinping;Zhao Wenjuan(Department of Neurology,Tianjin Huanhu Hospital,Tianjin 300050,China;Department of Emergency,Tianjin Huanhu Hospital,Tianjin 300050,China;Department of Neurology,the Second Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津市环湖医院神经内科,天津300050 [2]天津市环湖医院急诊科,天津300050 [3]天津医科大学第二附属医院神经内科,天津300211

出　　处：《中华神经科杂志》2024年第1期80-84,共5页Chinese Journal of Neurology

基　　金：国家自然科学基金(81901101);天津市卫生健康科技项目(TJWJ2022MS032);天津市医学重点学科(专科)建设项目(TJYXZDXK⁃052B)。

摘　　要：新型冠状病毒(SARS-CoV-2)感染(COVID-19)后伴发周围神经损害引起的COVID-19相关吉兰-巴雷综合征(GBS)是最常见的COVID-19相关神经系统炎性疾病之一,有较高的呼吸衰竭发生率及病死率。既往COVID-19相关GBS患者脑脊液中SARS-CoV-2 RNA阳性报道罕见。文中报道4例COVID-19相关GBS患者,在出现发热等症状并确诊COVID-19后4~15 d出现神经系统症状,均表现为进展性双下肢无力,3例患者伴有大小便障碍等自主神经功能损害表现,1例患者伴有双侧面神经麻痹、吞咽困难、复视和共济失调等多脑神经炎及Miller-Fisher综合征表现。神经电生理检查3例患者出现神经传导速度异常及F波出现率减低,另外1例患者存在下肢运动传导通路异常。有3例患者行抗神经节苷脂抗体检查,其中1例患者血GD1a-IgG阳性。对4例患者均行血液、脑脊液宏基因组二代测序检查,3例患者血液及脑脊液SARS-CoV-2 RNA阳性,1例患者脑脊液SARS-CoV-2 RNA阳性。COVID-19 associated Guillain-Barrésyndrome(GBS)caused by peripheral nerve damage after SARS-CoV-2 infection is one of the most common COVID-19 related nervous system inflammatory diseases,with high incidence of respiratory failure and mortality.Positive SARS-CoV-2 RNA in cerebrospinal fluid of COVID-19 associated GBS patients has been rarely reported.This paper reports 4 patients with COVID-19 associated GBS in China who developed neurological symptoms 4-15 days after fever and were confirmed SARS-CoV-2 infection.All patients presented with progressive weakness of both lower limbs,3 patients with autonomic dysfunction such as defecation and urination disorders,and 1 patient with polycranial neuritis and Miller-Fisher syndrome such as bilateral facial palsy,dysphagia,diplopia and ataxia.Nerve conduction velocity and F wave were abnormal in 3 patients,and motor conduction pathway was abnormal in 1 patient.Anti-ganglioside antibodies were tested in 3 patients,and GD1a-IgG was positive in 1 patient.All 4 patients underwent metagenomic next-generation sequencing examination in blood and cerebrospinal fluid.SARS-CoV-2 RNA was positive in blood and cerebrospinal fluid of 3 patients,and SARS-CoV-2 RNA was positive in cerebrospinal fluid of 1 patient.

关 键 词：新型冠状病毒感染 格林-巴利综合征 阿兹夫定 

分 类 号：R745.43[医药卫生—神经病学与精神病学]