Chiò A, Cocito D, Leone M, Giordana M T, Mora G, Mutani R
Department of Neuroscience, University of Turin, San Giovanni Battista Hospital, Italy.
Neurology. 2003 Apr 8;60(7):1146-50. doi: 10.1212/01.wnl.0000055091.96905.d0.
The authors evaluated the incidence and long-term prognostic factors of Guillain-Barré syndrome (GBS) in a prospective, population-based study.
Patients with GBS diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke criteria in the 2-year period 1995 to 1996 in two Italian regions were prospectively followed up for 2 years after onset of GBS.
A total of 120 patients were found, corresponding to a crude annual incidence rate of 1.36/100,000 population (95% CI, 1.13 to 1.63). A total of 7 (5.8%) patients, all but one with axonal or mixed EMG pattern, died acutely within 30 days from the onset of the disease. Acute mortality was due to respiratory involvement and intensive care unit complications. In multivariate analysis, a worse 2-year outcome (Hughes score >or=2) was related to a higher Hughes grade at nadir, axonal or mixed EMG, age >or=50 years, and absence of respiratory infections preceding GBS. The persistence of disability 2 years after the acute phase was related to axonal involvement and a worse status at nadir.
After adjustment to US population, the incidence rates for GBS from different countries showed no significant differences. Both acute mortality and long-term disability in GBS seem to be related to an axonal involvement and a Hughes grade >or=2 at nadir.
作者在一项基于人群的前瞻性研究中评估了吉兰-巴雷综合征(GBS)的发病率及长期预后因素。
1995年至1996年期间,在意大利两个地区,依据美国国立神经疾病与中风研究所的标准诊断出的GBS患者,在GBS发病后进行了为期2年的前瞻性随访。
共发现120例患者,粗年发病率为1.36/10万人口(95%可信区间,1.13至1.63)。共有7例(5.8%)患者在疾病发作后30天内急性死亡,除1例患者外,其余患者的肌电图表现均为轴索性或混合型。急性死亡率归因于呼吸受累及重症监护病房并发症。多因素分析显示,2年预后较差(休斯评分≥2)与最低点时较高的休斯分级、轴索性或混合型肌电图、年龄≥50岁以及GBS发作前无呼吸道感染有关。急性期后2年残疾的持续存在与轴索受累及最低点时较差的状态有关。
根据美国人群进行调整后,不同国家GBS的发病率无显著差异。GBS的急性死亡率和长期残疾似乎均与轴索受累及最低点时休斯分级≥2有关。