长期咀嚼槟榔的乙型肝炎合并吉兰-巴雷综合征七例并文献复习  

Hepatitis B complicated with Guillain-Barre syndrome after long-term chewing betel nut:seven cases report and literature review

作　　者：高妍 崔芳[1] 何子龙 张倩[1] Gao Yan;Cui Fang;He Zilong;Zhang Qian(Department of Neurology,Hainan Hospital of PLA General Hospital,Sanya 572000,China)

机构地区：[1]解放军总医院海南医院神经内科,三亚572000

出　　处：《北京医学》2025年第1期13-16,共4页Beijing Medical Journal

基　　金：海南省自然科学基金科(820QN383)。

摘　　要：目的探讨长期咀嚼槟榔的乙型肝炎合并吉兰-巴雷综合征(Guillain-Barre syndrome,GBS)患者的临床特点、治疗效果及发病机制。方法回顾性选取2016年11月至2021年12月解放军总医院海南医院神经内科长期咀嚼槟榔的乙型肝炎合并GBS患者7例,收集患者的临床表现,脑脊液检查和神经电生理检查结果,肝功能和HBV核酸定量,治疗及转归等,结合文献复习,总结GBS患者的临床特点及发病机制。结果7例患者均为男性,年龄24~33岁,平均28岁。患者主要临床表现为对称性进行性四肢麻木、无力,发病2周时达高峰,经免疫抑制剂治疗后恢复。肌电图提示上下肢周围神经源性受损,下肢重于上肢7例,感觉神经及运动神经均受损7例,其中感觉神经受损重于运动神经1例、轴索损伤为主7例;F波异常6例;AST和(或)ALT异常5例,HBV核酸定量升高5例。7例患者均给予免疫球蛋白静脉滴注(intravenous immunoglobulin infusion,IVIG)联合甲钴胺注射液营养神经治疗5 d,症状均有不同程度改善;发病半年后随访,7例患者病情基本不影响日常生活。结合病例及文献复习,考虑GBS发病机制为槟榔降低机体免疫系统功能、诱发或加重HBV感染肝脏,导致肝功能受损,并使机体发生免疫反应,导致GBS。结论长期咀嚼槟榔的乙型肝炎患者更容易发生GBS,临床表现以神经轴索损害为主。Objectives To explore the clinical characteristics,therapeutic effect and pathogenesis of hepatitis B patients complicated with Guillain-Barre syndrome(GBS)after chewing betel nut for a long time.Methods A total of seven patients with hepatitis B complicated with GBS who chewed betel nut for a long time from the Department of Neurology,Hainan Hospital,General Hospital of PLA from November 2016 to December 2021 were retrospectively selected.The clinical manifestations,cerebrospinal fluid examination and neuroelectrophysiological examination results,liver function,HBV nucleic acid quantification,treatment and prognosis of GBS patients were summarized with literature review.Results All seven patients were males,aged from 24 to 33 years,with an average of 28 years.The main clinical manifestations of the patients was symmetrical progressive limb numbness and weakness,peaking in about two weeks and recovered after treatment with immunosuppressants.Electromyography showed that peripheral neurogenic damage in the upper and lower limbs,with lower limbs heavier than upper limbs in seven cases,and sensory and motor nerves damage in seven cases,including one case of sensory nerve being more severe than motor nerve,and seven cases of mainly axonal injury.There were six cases with abnormal F wave,and five cases with abnormal AST and/or ALT.The nucleic acid quantification of HBV was increased in five cases.Seven patients were treated with intravenous immunoglobulin infusion(IVIG)combined with mecobalamin injection for 5 d,and the symptoms were improved to varying degrees.Follow-up after half a year of onset,seven patients'condition basically did not affect their daily life.Combined with cases and literature review,the pathogenesis of GBS was that betel nut could reduce the immune system function,induce or aggravate HBV infection to the liver,which leaded to liver function damage,and made the body have an immune response,and finally led to GBS.Conclusions Hepatitis B patients who chew betel nut for a long time are more likely to

关 键 词：槟榔 HBV 吉兰-巴雷综合征 

分 类 号：R74[医药卫生—神经病学与精神病学]