吉兰-巴雷综合征患者前驱感染与脑脊液蛋白-细胞分离现象的关系  

Association between antecedent infection and albuminocytologic dissociation in cerebrospinal fluid of patients with Guillain-Barrésyndrome

作　　者：王子豪 宋进[2] 胡铭[2] 张国荣[2] 单方振 邢春叶 宋艳[2] 乔保俊 王玉忠[2] Wang Zihao;Song Jin;Hu Ming;Zhang Guorong;Shan Fangzhen;Xing Chunye;Song Yan;Qiao Baojun;Wang Yuzhong(Qilu Medical College,Shandong University,Ji’nan 250012,China;不详)

机构地区：[1]山东大学齐鲁医学院,济南250012 [2]济宁医学院附属医院神经内科,济宁272029

出　　处：《新医学》2024年第2期112-116,共5页Journal of New Medicine

基　　金：国家自然科学基金(81771298,82101420)。

摘　　要：目的比较不同前驱感染阳性的吉兰-巴雷综合征(GBS)患者脑脊液蛋白-细胞分离现象以及蛋白水平差异,探讨前驱感染与GBS患者脑脊液蛋白升高的关系。方法收集198例GBS患者的临床资料以及脑脊液分析结果,使用ELISA对患者血清进行14种感染性病原体血清学检测,分析不同前驱感染的GBS患者中脑脊液蛋白-细胞分离的比例及蛋白水平的差异。结果55.1%(109/198)的GBS患者感染性病原体血清学阳性,主要为空肠弯曲菌23.7%(47/198)、甲型流感病毒20.7%(41/198)、乙型流感病毒15.2%(30/198),其中18.7%(37/198)的患者2种或以上病原体血清学阳性。73.7%(146/198)的患者存在脑脊液蛋白-细胞分离现象。在单一病原体血清学阳性患者中,空肠弯曲菌感染阳性患者的脑脊液蛋白-细胞分离现象为83.3%(25/30),甲型流感病毒感染阳性患者为100%(18/18),乙型流感病毒感染阳性患者为6/7,甲型肝炎病毒感染阳性患者为4/5,登革热病毒感染阳性患者为4/5,肺炎支原体感染阳性患者为4/4;EB病毒感染阳性、单纯疱疹病毒感染阳性、水痘带状疱疹病毒感染阳性患者各1例,均出现脑脊液蛋白-细胞分离现象;2种或以上病原体感染的患者中62.2%(23/37)出现脑脊液蛋白-细胞分离现象;无前驱感染者中66.3%(59/89)出现脑脊液蛋白-细胞分离现象。脑脊液蛋白-细胞分离现象在无前驱感染以及有不同类型前驱感染患者中的总阳性率比较差异有统计学意义(P=0.007),但脑脊液蛋白水平比较差异无统计学意义(P>0.05)。结论GBS患者中脑脊液蛋白-细胞分离现象与前驱感染的类型有关,其中甲型流感病毒感染患者发生脑脊液蛋白-细胞分离现象的比例最高。Objective To analyze the albuminocytologic dissociation in cerebrospinal fluid(CSF)and differences in CSF protein levels in Guillain-Barrésyndrome(GBS)patients with various types of antecedent infections and investigate the correlation between antecedent infections and increased CSF protein levels in GBS patients.Methods Clinical data and CSF analysis results of 198 GBS patients were collected.Enzyme-linked immunosorbent assay(ELISA)was employed to detect 14 types of infectious pathogens in the serum of GBS patients.The proportion of albuminocytologic dissociation and the differences in CSF protein levels were analyzed in GBS patients with different antecedent infections.Results In total,55.1%(109/198)of GBS patients had serological positivity for infectious pathogens,23.7%(47/198)for Campylobacter jejuni,20.7%(41/198)for Influenza A virus,15.2%(30/198)for Influenza B virus.Among them,18.7%(37/198)of GBS patients had serological positivity for two or more pathogens.In total,73.7%(146/198)of GBS patients had albuminocytologic dissociation in CSF.Among single pathogen-positive patients,83.3%(25/30)of Campylobacter jejuni positive patients showed albuminocytologic dissociation in CSF,100%(18/18)of Influenza A virus patients,6/7 of influenza B virus patients,4/5 of Hepatitis A virus patients,4/5 of Dengue virus patients,4/4 of Mycoplasma pneumoniae patients,1/1 of Epstein-Barr virus patients,1/1 of herpes simplex virus patients,and 1/1 of Varicella-zoster virus patients had albuminocytologic dissociation in CSF.Among patients infected with two or more pathogens,62.2%(23/37)showed albuminocytologic dissociation in CSF,while 66.3%(59/89)of GSB patients without antecedent infection had albuminocytologic dissociation in CSF.The positive rates of albuminocytologic dissociation in CSF exhibited significant differences among patients without and with various types of antecedent infections(P=0.007),whereas no significant difference was noted in CSF protein levels(P>0.05).Conclusion The albuminocytologic dissociation in CSF

关 键 词：吉兰-巴雷综合征 前驱感染 脑脊液蛋白-细胞分离现象 

分 类 号：R745.43[医药卫生—神经病学与精神病学]