Logina I, Donaghy M
Department of Neurology and Neurosurgery, Medical Academy of Latvia, P Stradin's Clinical Hospital, 13 Pilsonu St, Riga, LV-1002, Latvia.
J Neurol Neurosurg Psychiatry. 1999 Oct;67(4):433-8. doi: 10.1136/jnnp.67.4.433.
Clinical features of 50 adults with diphtheritic polyneuropathy (DP) were studied in Riga, Latvia and compared with 21 patients with Guillain-Barré syndrome (GBS).
Neurological complications occurred in 15% of patients admitted to hospital with diphtheria and usually after severe pharyngeal infection. Bulbar dysfunction occurred in 98% of patients with DP and only 10% of patients with GBS. Limb weakness was mild or absent in 30% of patients with DP. Ventilation dependent respiratory failure occurred in 20% of patients with DP. The first symptoms of DP occurred 2-50 days after the onset of local diphtheria infection. Neurological deterioration in DP continued for a median of 49 (range 15-83) days and improvement started 73 (range 20-115) days after onset. In 66% of patients with DP, the neuropathy was biphasic with a secondary worsening after 40 days. By contrast patients with GBS worsened for only 10 days on average (range 2-28 days) and improved after 21 (range 4-49) days. Eight patients with DP died, four from severe cardiomyopathy and four from multiple diphtheritic organ failure. Prolonged distal motor latencies (DMLs) were common to both DP and GBS, and more pronounced than motor conduction slowing. Limb symptoms continued after 1 year in 80% of the patients with DP, 6% were unable to walk independently, but independent respiratory and bulbar function had returned in all survivors. By comparison no patients with GBS died and none were severely disabled after 1 year. No death, in patients with DP occurred after antitoxin on days 1 or 2 after onset of diphtheria symptoms, whereas identical rates of death and peak severity of DP were seen both in those who received antitoxin on days 3-6 and those who did not receive it at all.
Diphtheric polyneuropathy is much more likely than GBS to have a bulbar onset, to lead to respiratory failure, to evolve more slowly, to take a biphasic course, and to cause death or long term disability. Antitoxin seems ineffective if administered after the second day of diphtheritic symptoms.
对拉脱维亚里加50例成人白喉性多神经病（DP）患者的临床特征进行研究，并与21例吉兰 - 巴雷综合征（GBS）患者进行比较。
因白喉入院的患者中15%发生神经并发症，通常在严重咽部感染后出现。98%的DP患者出现球部功能障碍，而GBS患者中仅10%出现。30%的DP患者肢体无力轻微或无肢体无力症状。20%的DP患者出现依赖通气的呼吸衰竭。DP的首发症状出现在局部白喉感染发病后2至50天。DP患者神经功能恶化持续时间中位数为49天（范围15 - 83天），发病后73天（范围20 - 115天）开始改善。66%的DP患者神经病变呈双相性，40天后出现继发性恶化。相比之下，GBS患者平均恶化仅10天（范围2 - 28天），21天（范围4 - 49天）后改善。8例DP患者死亡，4例死于严重心肌病，4例死于多发性白喉器官衰竭。DP和GBS患者均常见远端运动潜伏期（DML）延长，且比运动传导减慢更明显。DP患者中80%在1年后仍有肢体症状，6%无法独立行走，但所有幸存者均恢复了独立呼吸和球部功能。相比之下，GBS患者1年后无死亡病例，也无严重残疾者。白喉症状出现后第1天或第2天使用抗毒素的DP患者无死亡病例，而在症状出现后第3 - 6天使用抗毒素的患者和未使用抗毒素的患者中，DP的死亡率和严重程度峰值相同。
与GBS相比，白喉性多神经病更易出现球部起病、导致呼吸衰竭、进展更缓慢、呈双相病程，并导致死亡或长期残疾。白喉症状出现第二天后使用抗毒素似乎无效。
