Nishimoto Yukihiro, Susuki Keiichiro, Yuki Nobuhiro
Department of Pediatrics, Nanki Fukushi Center, Wakayama, Japan.
Pediatr Neurol. 2008 Jul;39(1):67-70. doi: 10.1016/j.pediatrneurol.2008.03.014.
Guillain-Barré syndrome is divided into two subtypes: acute inflammatory demyelinating polyneuropathy, and acute motor axonal neuropathy. Autoantibodies to gangliosides GM1, GM1b, GD1a, or GalNAc-GD1a were proposed as serologic markers of acute motor axonal neuropathy in adults. In a previous study of Japanese children with Guillain-Barré syndrome, acute motor axonal neuropathy was associated with anti-GM1 immunoglobulin G antibodies. Larger, comprehensive studies are required to confirm this finding. The present study revealed that immunoglobulin G antibodies were against GM1 (34%), GM1b (22%), GD1a (25%), GalNAc-GD1a (13%), and any of these (44%) in 32 Japanese children with Guillain-Barré syndrome. Patients who had the autoantibodies more often manifested previous diarrhea (71% vs 11%, P = 0.001), acute motor axonal neuropathy (64% vs 11%, P = 0.003), and slower recovery (healthy at final follow-up: 29% vs 78%, P = 0.011; able to run with minor signs, 64% vs 11%, P = 0.003) than patients who did not. The clinical features were consistent with those in adults carrying anti-ganglioside antibodies. Anti-ganglioside antibody testing may help predict outcomes in pediatric patients with Guillain-Barré syndrome who prefer not to undergo repeated nerve-conduction studies.
吉兰-巴雷综合征分为两种亚型：急性炎症性脱髓鞘性多发性神经病和急性运动轴索性神经病。抗神经节苷脂GM1、GM1b、GD1a或GalNAc-GD1a自身抗体被认为是成人急性运动轴索性神经病的血清学标志物。在之前一项针对日本吉兰-巴雷综合征患儿的研究中，急性运动轴索性神经病与抗GM1免疫球蛋白G抗体有关。需要开展更大规模、更全面的研究来证实这一发现。本研究显示，32例日本吉兰-巴雷综合征患儿中，免疫球蛋白G抗体针对GM1的占34%，针对GM1b的占22%，针对GD1a的占25%，针对GalNAc-GD1a的占13%，针对上述任何一种的占44%。有自身抗体的患者比没有自身抗体的患者更常出现既往腹泻（71%对11%，P = 0.001）、急性运动轴索性神经病（64%对11%，P = 0.003），且恢复较慢（末次随访时恢复健康：29%对78%，P = 0.011；能带着轻微体征跑步：64%对11%，P = 0.003）。这些临床特征与携带抗神经节苷脂抗体的成人患者一致。抗神经节苷脂抗体检测可能有助于预测不愿接受重复神经传导研究的吉兰-巴雷综合征患儿的预后。
