吉兰-巴雷综合征严重程度早期预测因素  

Predictors at nadir of severity on patients with Guillain-Barré syndrome

作　　者：彭茂[1] 贾建平[1] 

机构地区：[1]首都医科大学宣武医院神经内科,北京100053

出　　处：《中华神经科杂志》2004年第2期154-157,共4页Chinese Journal of Neurology

摘　　要：目的　探讨吉兰 巴雷综合征 (Guillain Barr啨ｓｙｎｄｒｏｍ ,GBS)早期症状和辅助检查中与疾病最终严重程度 (指停滞在轻型或需要机械通气两种情况 )相关的因素 ,筛选出预测性指标 ,以指导早期的干预措施和治疗方案。方法　收集 1996～ 2 0 0 2年北京宣武医院收治的 12 3例GBS病例 ,将GBS划分为轻型 (即在整个病程中可独立行走或双下肢肌力均在Ⅳ级以上 )和非轻型 ,或划分为需要机械通气者和不需要机械通气者 ,应用Logistic模型分析疾病最终严重程度的相关因素和预测因素。结果　共 12 3例患者 ,32例为轻型GBS ,2 9例需要机械通气。男性且进展期无延髓部功能障碍的患者容易停滞在轻型。发展为轻型的可能性 ,男性是女性的 3 33倍 ,无延髓部症状是有延髓部症状的 2 0 17倍。发病前无腹泻且进展期有延髓部功能障碍的患者容易进展至需要机械通气。使用呼吸机的风险 ,无腹泻者是有腹泻者的 4 81倍 ,有延髓部症状者是无延髓部症状的 18 87倍。进展期具有双侧面瘫的患者多见于需要机械通气的患者 ,但该临床表现对病情的发展无预测意义。结论　患者性别、发病前有无腹泻、病情达高峰前是否存在延髓部功能障碍在一定程度上能够预测GBS的发展趋势。对有可能需要机械通气的患者应早期干预。Objective To explore the factors relating to the severity of Guillain-Barré syndrome (GBS) (i.e. of being the mild form or in need of mechanical ventilation), and to find the predictors in early clinical presentations and laboratory investigations as to guiding the early management of GBS. Methods All 123 cases of patients with GBS admitted to Xuanwu Hospital from 1996-2002 were collected, and divided into two groups based on the international criteria for different severity of GBS. Mildly affected patients (i.e. able to walk unaided during the whole course or the Medical Research Council [MRC] muscle power grading scale≥4 in both lower limbs at nadir) and ventilated patients (i.e. in need of mechanical ventilation) were divided in this study. Characteristics of each group in early clinical presentations and laboratory investigations were analyzed in univariate conditional Logistic model in order to find out the predictors. Results In all 123 patients studied, 32 were having mild GBS; 29 severe GBS (i.e. in need of mechanical ventilation during the course). Men (P=0.047) and patients without bulbar dysfunction (P=0.002) were more likely to become mild GBS. The possibility of being mild form was 3.33∶1 between man and woman, 1∶20.17 between those with and without bulbar dysfunction. Patients with bulbar dysfunction (P<0.001) and without previous diarrhea infection (P<0.001)were more likely needing the mechanical ventilation. The possibility of mechanical ventilation was 1∶4.81 between those with and without diarrhea, 18.87∶1 between those with and without bulbar dysfunction. Bilateral facial weakness (P<0.001) before nadir were more frequently seen in patients needing mechanical ventilation, but there is no predictive value. Conclusion Sex, diarrhea and bulbar dysfunction before nadir might be valuable predictors for the severity of GBS. Knowing these predictors might be helpful on early management for those who need mechanical ventilation.

关 键 词：吉兰-巴雷综合征 GBS 延髓部 辅助检查 功能障碍 

分 类 号：R745.43[医药卫生—神经病学与精神病学]