Nachamkin I, Arzarte Barbosa P, Ung Huong, Lobato C, Gonzalez Rivera A, Rodriguez P, Garcia Briseno A, Cordero L Maria, Garcia Perea L, Perez J Carlos, Ribera M, Aldama P Chico, Guitérrez G Dávila, Sarnat L Flores, García M Ruiz, Veitch J, Fitzgerald C, Cornblath D R, Rodriguez Pinto M, Griffin J W, Willison H J, Asbury A K, McKhann G M
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, 3400 Spruce Street, 4th Floor Gates Building, Philadelphia, PA 19104-4283, USA.
Neurology. 2007 Oct 23;69(17):1665-71. doi: 10.1212/01.wnl.0000265396.87983.bd. Epub 2007 Sep 26.
Guillain-Barré syndrome (GBS) is an acute, immune-mediated flaccid paralysis frequently associated with Campylobacter infection. Of two predominant GBS subtypes, a demyelinating subtype (acute inflammatory demyelinative polyneuropathy [AIDP]) predominates in the United States and Europe, and axonal subtype (acute motor axonal neuropathy [AMAN]) is the predominant form in China. Previous clinical studies suggested that AMAN also occurs in Mexican children. The purpose of this study was to describe the subtypes of GBS in children from Mexico City.
We prospectively studied 121 children admitted to two pediatric hospitals in Mexico City from 1996 to 2002. Clinical histories were obtained, electrophysiologic studies were performed to determine GBS subtype, and microbiologic studies were performed.
Of the 121 children, 46 had AMAN and 32 had AIDP. The male to female ratio was 1.3 for AMAN cases (mean age = 6.3) and 3.0 for AIDP cases (mean age = 7.0). There was a strong seasonal distribution of AMAN cases in July to September. Children with AMAN, but not AIDP, had worsening of illness during hospitalization as judged by peak severity scores. Vomiting was more likely in AIDP (28.1%) vs AMAN (6.5%) (p = 0.012) and diarrhea was more common in AMAN (32.6%) than AIDP (12.5%) (p = 0.06). IgG anti-GM1 antibody titers were higher in patients with AMAN vs AIDP (p = 0.067). Anti-GD1a antibodies were equally present in both groups. Anti GQ1b titers were higher in AMAN vs AIDP (p = 0.009). Campylobacter antibody responses were positive in 44.1% of patients with AMAN and 37.0% of patients with AIDP. Twenty patients (14 = AMAN, 6 = AIDP) had positive stool cultures for C jejuni. Two serotypes, HS:19 and HS:41, accounted for 6 of 10 Campylobacter isolates available for serotyping from these cases.
This study confirms that acute motor axonal neuropathy is an important Guillain-Barré syndrome subtype in Mexican children, is associated with diarrhea, and occurs seasonally.
吉兰 - 巴雷综合征（GBS）是一种急性免疫介导的弛缓性麻痹，常与空肠弯曲菌感染相关。在GBS的两种主要亚型中，脱髓鞘亚型（急性炎症性脱髓鞘性多发性神经病[AIDP]）在美国和欧洲占主导地位，而轴索性亚型（急性运动轴索性神经病[AMAN]）在中国是主要形式。先前的临床研究表明，AMAN在墨西哥儿童中也有发生。本研究的目的是描述墨西哥城儿童GBS的亚型。
我们对1996年至2002年在墨西哥城两家儿科医院住院的121名儿童进行了前瞻性研究。获取了临床病史，进行了电生理研究以确定GBS亚型，并开展了微生物学研究。
121名儿童中，46例为AMAN，32例为AIDP。AMAN病例的男女比例为1.3（平均年龄 = 6.3岁），AIDP病例为3.0（平均年龄 = 7.0岁）。AMAN病例在7月至9月有明显的季节性分布。根据峰值严重程度评分判断，AMAN患儿（而非AIDP患儿）在住院期间病情恶化。AIDP患儿呕吐更常见（28.1%），而AMAN患儿为6.（5%）（p = 0.012）；腹泻在AMAN患儿中更常见（32.6%），而AIDP患儿为12.5%（p = 0.06）。AMAN患者的IgG抗GM1抗体滴度高于AIDP患者（p = 0.067）。两组中抗GD1a抗体均有存在。AMAN患者的抗GQ1b滴度高于AIDP患者（p = 0.009）。AMAN患者中44.1%和AIDP患者中37.0%的空肠弯曲菌抗体反应呈阳性。20名患者（14例AMAN，6例AIDP）粪便培养出空肠弯曲菌阳性。两种血清型，HS:19和HS:41，占这些病例中可进行血清分型的10株空肠弯曲菌分离株中的6株。
本研究证实，急性运动轴索性神经病是墨西哥儿童GBS的一种重要亚型；与腹泻相关，且具有季节性。
