Tasdemir Haydar Ali, Dilber Cengiz, Kanber Yilmaz, Uysal Serap
Department of Pediatrics, Kahramanmaras Sutcu Imam University, Medical Faculty, Turkey.
J Child Neurol. 2006 Nov;21(11):972-4. doi: 10.1177/08830738060210110701.
Guillain-Barré syndrome is an acute inflammatory demyelinating neuropathy characterized by progressive symmetric polyradiculoneuritis, predominantly manifested by weakness and areflexia. In this article, we report our findings in 25 children treated with intravenous immunoglobulin and compare them with the remaining 30 children who received supportive care only. Only supportive care was given to 30 children who were not able to receive intravenous gammaglobulin because of shortcomings in intravenous gammaglobulin availability owing to a poor import during those years. Twenty-five patients were treated with intravenous gammaglobulin; they received intravenous gammaglobulin 0.4 g/kg/day for 5 consecutive days. Seventeen of the intravenous gammaglobulin group had received intravenous gammaglobulin within 10 days after the first symptoms, and eight of them had received intravenous gammaglobulin after the first 10 days. The average time elapsed for the symptoms to reach the maximum level was 6.9 (range 4-12) days in patients receiving intravenous gammaglobulin in the first 10 days, and it was significantly shorter than the time elapsed for the supportive care group (6.9 versus 8.8 days, respectively) (P < .05). Admission to the hospital after the first symptom, disability grade, time to improve in disability grade, the period of hospitalization, and mortality were not different in the intravenous gammaglobulin and supportive care groups (P > .05). Our suggestion for intravenous gammaglobulin treatment in Guillain-Barré syndrome is that if the patient has risk factors for respiratory insufficiency, then the treatment should be started. We more confidently carry out the follow-up of these patients after the results of this study. In conclusion, although it has been reported that intravenous gammaglobulin facilitates improvement in the disease and the decrease in mortality in children with Guillain-Barré syndrome, it has been mentioned in some studies that the intravenous gammaglobulin treatment was not better than supportive care, as in our study. However, further studies are essential to determine when intravenous gammaglobulin should be given to patients having which clinical and laboratory findings.
吉兰 - 巴雷综合征是一种急性炎症性脱髓鞘性神经病，其特征为进行性对称性多神经根神经炎，主要表现为无力和腱反射消失。在本文中，我们报告了25例接受静脉注射免疫球蛋白治疗的儿童的研究结果，并将其与另外30例仅接受支持治疗的儿童进行比较。由于那些年进口不佳导致静脉注射球蛋白供应不足，30例儿童无法接受静脉注射球蛋白，因此仅给予支持治疗。25例患者接受了静脉注射球蛋白治疗；他们连续5天接受0.4g/kg/天的静脉注射球蛋白。静脉注射球蛋白组中有17例在出现首发症状后的10天内接受了静脉注射球蛋白，其中8例在首发症状出现10天后接受了静脉注射球蛋白。在首发症状出现后的前10天内接受静脉注射球蛋白的患者中，症状达到最高水平的平均时间为6.9（范围4 - 12）天，明显短于支持治疗组（分别为6.9天和8.8天）（P <.05）。静脉注射球蛋白组和支持治疗组在首发症状后入院、残疾等级、残疾等级改善时间、住院时间和死亡率方面无差异（P>.05）。我们对吉兰 - 巴雷综合征静脉注射球蛋白治疗的建议是，如果患者有呼吸功能不全的危险因素，则应开始治疗。在本研究结果出来后，我们更有信心对这些患者进行随访。总之，尽管有报道称静脉注射球蛋白有助于改善吉兰 - 巴雷综合征患儿的病情并降低死亡率，但在一些研究中也提到，静脉注射球蛋白治疗并不比支持治疗更好，就像我们的研究一样。然而，进一步的研究对于确定何时应对具有哪些临床和实验室检查结果的患者给予静脉注射球蛋白至关重要。
