Brannagan Thomas H, Zhou Yili
Department of Neurology, Weill Medical College of Cornell University, Peripheral Neuropathy Center, 635 Madison Avenue, Suite 400, New York, NY 10022, USA.
J Neurol Sci. 2003 Apr 15;208(1-2):39-42. doi: 10.1016/s0022-510x(02)00418-5.
Human immunodeficiency virus-associated Guillain-Barré syndrome (HIV-GBS) has been reported since 1985. Based on previous reports, this neuropathy typically occurs early in HIV infection, even at seroconversion, prior to developing acquired immunodeficiency syndrome (AIDS). Patients with GBS and CD4 counts of <50 have been proposed to have cytomegalovirus (CMV) infection and empiric gancyclovir is recommended. We reviewed medical records of 10 patients with HIV-GBS at five hospitals from 1986 to 1999. The mean CD4 count was 367/mm(3) (range 55-800). GBS was the first symptom of HIV infection in three patients. Four patients had AIDS with CD4 counts ranging from 55 to 190. CSF white blood cell (WBC) was 0 wbc/mm(3) in four patients, 2-10 wbc/mm(3) in three and 11-17 wbc/mm(3) in two. Three had recurrent weakness from 9 weeks to 4 years after the onset of symptoms, which persisted. HIV-GBS occurs in early and late stages of HIV infection, and may follow the onset of AIDS. No patients were seen with severe immunosuppression (CD4<50). A mild cerebrospinal fluid (CSF) pleocytosis in GBS suggests HIV infection, but is frequently absent. Compared to HIV-negative people, HIV-GBS may be associated with more frequent recurrent episodes or the development of CIDP.
自1985年以来，已有人类免疫缺陷病毒相关格林-巴利综合征（HIV-GBS）的报道。根据既往报告，这种神经病变通常发生在HIV感染早期，甚至在血清转化时，即在获得性免疫缺陷综合征（AIDS）出现之前。有提议认为，格林-巴利综合征患者且CD4计数<50者存在巨细胞病毒（CMV）感染，建议经验性使用更昔洛韦。我们回顾了1986年至1999年期间五家医院10例HIV-GBS患者的病历。平均CD4计数为367/mm³（范围55 - 800）。3例患者中GBS是HIV感染的首发症状。4例患者患有AIDS，CD4计数范围为55至190。4例患者脑脊液白细胞（WBC）为0个白细胞/mm³，3例为2 - 10个白细胞/mm³，2例为11 - 17个白细胞/mm³。3例患者在症状出现后9周内至4年出现反复肌无力，且持续存在。HIV-GBS发生于HIV感染的早期和晚期，可能在AIDS发病之后出现。未发现有严重免疫抑制（CD4<50）的患者。GBS患者脑脊液（CSF）轻度细胞增多提示HIV感染，但常无此表现。与HIV阴性者相比，HIV-GBS可能与更频繁的复发或慢性炎症性脱髓鞘性多发性神经病（CIDP）的发生有关。
