吉兰⁃巴雷综合征患者抗GM1抗体与抗甲状腺抗体的相关性研究  

Correlation between anti⁃GM1 antibody and anti⁃thyroid antibody in Guillain⁃Barrésyndrome patients

作　　者：詹慧 常蕾蕾[1] 孟海兰 陈燕婷[1] 陈妍[1] ZHAN Hui;CHANG Leilei;MENG Hailan;CHEN Yanting;CHEN Yan(Department of Neurology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属南京鼓楼医院神经内科,江苏南京210008

出　　处：《南京医科大学学报（自然科学版）》2024年第3期360-366,共7页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(82271335);江苏省自然科学基金(BK20221170)。

摘　　要：目的:探讨吉兰⁃巴雷综合征(Guillain⁃Barrésyndrome,GBS)患者抗甲状腺抗体与抗神经节苷脂GM1抗体的相关性。方法:收集2018年7月—2023年2月南京大学医学院附属鼓楼医院神经内科收治的同时检测抗甲状腺抗体和抗神经节苷脂抗体(antiganglioside antibody,AGA)水平的60例GBS患者,根据抗甲状腺抗体结果将患者分为正常组和异常组,比较两组患者的临床特征、甲状腺功能以及AGA比例。结果:与正常组相比,甲状腺功能异常组中GBS患者抗神经节苷酯GM1抗体和GM2抗体水平人明显升高,并伴有更严重的临床症状(P<0.05)。多因素Logistic回归分析显示,GBS患者抗甲状腺抗体异常(OR=5.184,95%CI:1.377~19.518,P=0.015)以及游离甲状腺素(free thyroxine,FT4)水平升高(OR=1.266,95%CI:1.009~1.588,P=0.030),是导致抗GM1抗体阳性率增加的独立危险因素。受试者工作特征(receiver operation characteristic,ROC)曲线显示甲状腺过氧化物酶抗体(thyroperoxidase antibody,TPO⁃Ab)预测GM1阳性的最佳阈值为47.9 U/mL,灵敏度为66.7%,特异度为77.8%。甲状腺球蛋白抗体(thyroglobulin antibody,Tg⁃Ab)预测GM1阳性的最佳阈值为20.0 U/mL,灵敏度为73.3%,特异度为73.3%。结论:合并抗甲状腺抗体异常的GBS患者更易出现抗GM1抗体阳性,这可能是合并甲状腺功能异常的GBS患者预后更差的可能机制。Objective:We aimed to explore the relationship between thyroid autoantibodies and anti⁃GM1 antibody in Guillain⁃Barrésyndrome(GBS)patients.Methods:We selected 60 GBS patients who were admitted to Nanjing Drum Tower Hospital from July 2018 to February 2023 and tested for both anti⁃thyroid antibodies and Antiganglioside antibody(AGA)levels.According to anti⁃thyroid antibodies,the patients were divided into normal group and abnormal group.The clinical characteristics,thyroid function and the proportion of AGA in the two groups were compared.Results:Compared with the normal group,GBS patients in the abnormal group had significantly increased anti⁃GM1 antibody(Ab)(P<0.05)and anti⁃GM2 Ab(P<0.05),and were accompanied by more severe clinical symptoms(P<0.05).Multivariate logistic regression analysis showed that the presence of abnormal anti⁃thyroid antibodies[OR=5.184,95%CI:1.377-19.518,P=0.015]and increased free thyroxine(FT4)levels[OR=1.266,95%CI:1.009-1.588,P=0.030]were independent risk factors for increased anti⁃GM1 antibody positive rate in GBS patients.Receiver operation characteristic(ROC)curve analysis found that the optimal threshold for thyroperoxidase antibody(TPO⁃Ab)to predict anti⁃GM1 Ab positive was 47.9 U/mL,with a sensitivity of 66.7%and a specificity of 77.8%.The optimal threshold for thyroglobulin antibody(Tg⁃Ab)to predict anti⁃GM1 Ab positive was 20.0 U/mL,with a sensitivity of 73.3%and a specificity of 73.3%.Conclusion:Our results suggest an association between thyroid autoantibodies and anti⁃GM1 antibody in GBS patients,potentially explaining the poorer prognosis of GBS patients with thyroid dysfunction.

关 键 词：吉兰⁃巴雷综合征 抗神经节苷脂抗体 抗神经节苷脂GM1抗体 甲状腺过氧化物酶抗体 甲状腺球蛋白抗体 

分 类 号：R745[医药卫生—神经病学与精神病学]