临床儿科杂志 ›› 2018, Vol. 36 ›› Issue (6): 428-.doi: 10.3969/j.issn.1000-3606.2018.06.007

• 综合报道 • 上一篇    下一篇

儿童脱髓鞘型和轴突型吉兰 - 巴雷综合征临床、 神经电生理特征和预后

孙瑞迪 1, 崔琳 1, 李承 1, 罗小青 1, 冯丽 1, 余晓莉 1, 刘智胜 2, 江军 1   

  1. 华中科技大学同济医学院附属武汉儿童医院1.神经电生理室,2.神经内科(湖北武汉 421000)
  • 收稿日期:2018-06-15 出版日期:2018-06-15 发布日期:2018-06-15
  • 通讯作者: 江军 E-mail:jiangjunzm@163.com
  • 基金资助:
    武汉市科技创新平台-儿童神经疾病临床医学研究中心资助项目(No.武科计2014-160);院内课题支持项目(No.2017FE002)

The clinical menifestation, electrophysiological characteristics, and prognosis of demyelinating and axonal Guillain- Barré syndrome in children

 SUN Ruidi1, CUI Lin1, LI Cheng1, LUO Xiaoqing1, FENG Li1, YU Xiaoli1, LIU Zhisheng2, JIANG Jun1   

  1. 1.Department of Electrophysiology, 2. Department of Neurology, Wuhan Children Hospital, Wuhan 421000, Hubei, China
  • Received:2018-06-15 Online:2018-06-15 Published:2018-06-15

摘要:  目的 探讨儿童脱髓鞘型和轴突型吉兰-巴雷综合征(GBS)的临床、神经电生理特征和预后。方法 81例 GBS患儿根据2次神经电生理检查结果分为脱髓鞘型和轴突型,分析两组患儿的临床、神经电生理特征和预后。结果 脱 髓鞘型GBS 60例、轴突型 21例,在轴突型GBS患儿中,具有可逆性传导阻滞者5例。轴突性GBS患儿起病到病程高峰期的 时间短于脱髓鞘型,血液抗神经节苷酯抗体更多见,差异有统计学意义(P均<0.05);两组间起病年龄、前驱感染病史、感 觉症状、颅神经受累、自主神经功能受损、脑脊液蛋白-细胞分离、入院时和高峰HG评分差异均无统计学意义(P>0.05)。 在轴突型GBS中具有可逆传导阻滞患儿较不具有可逆传导阻滞患儿恢复快,差异有统计学意义(P<0.01)。 轴突型和脱髓 鞘型GBS患儿之间的短期预后(出院后2个月)和长期预后(出院后1年)的差异均无统计学意义(P>0.05)。 结论 轴突型 GBS较脱髓鞘型临床进展更迅速,但两者的预后无明显区别;具有可逆传导阻滞的轴突型GBS恢复更快。

Abstract:  Objective To explore the clinical menifestation, electrophysiological characteristics and prognosis of demyelinating and axonal Guillain-Barré syndrome (GBS) in children. Method A total of 81 children with GBS were divided into demyelinating  and axonal subtypes according to the results of two electrophysiological examinations. And the clinical, neuro electrophysiological characteristics and prognosis of the two groups were analyzed. Results There were 60 cases of demyelinating GBS and 21 cases of axonal GBS. In children with axonal GBS, there were 5 cases of reversible conduction block. The interval of onset to fastigium in axonal GBS was shorter than that of demyelinating subtype, and blood antiganglioside antibody was more common, and there were statistically differences (P all<0.05). The age at onset, the history of the prodromal infection, the sensory symptoms, the cranial nerve involvement, the impairment of the autonomic nervous function, the cerebrospinal fluid protein-cell separation, and the HG scores at the time of admission and during fastigium were similar between the two groups (P>0.05). Children with reversible conduction block had faster recovery than those without reversible conduction block in axonal GBS, and there was statistical differences (P<0.01). There was no difference in short-term prognosis (2 months after discharge) and long-term prognosis (1 years after discharge) between the axonal GBS and demyelinating GBS children (P>0.05). Conclusion Axonal GBS clinically progressed more rapidly than demyelinating subtype, but there was no difference in prognosis between them. Also, axonal GBS with a reversible conduction block recovered faster.