格林-巴利综合征：朱拉隆功国王纪念医院的一项临床研究。

Areeyapinan Pongpak, Phanthumchinda Kammant

Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

J Med Assoc Thai. 2010 Oct;93(10):1150-5.

BACKGROUND

Guillain-Barre Syndrome (GBS) is an acute,fatal, but treatable polyradiculopathy. Clinical data concerning this entity is scarce in Thailand The purpose of the present study was to describe clinical profiles and management of GBS as well as to determine prognostic factors in GBS.

MATERIAL AND METHOD

Clinical data of GBS in King Chulalongkorn Memorial Hospital during 2002-2007 were searched by using in-patients hospital database. Asbury and Cornblath's criteria were applied for the diagnosis of GBS. Clinical data, electrophysiological data, management, and clinical prognostic factors were collected and analyzed by SPSS version 16.

RESULTS

Fifty-five patients with GBS were recruited, 26 wire male and 29 were female. Mean age was 43 +/- 17 years. History of antecedent infection included: respiratory tract 29%, gastrointestinal tract 7%, ear 2%, and non-specific infection 14%. Initial presentations were limb weakness 87%, limb numbness 78%, bulbar weakness 31%, and facial weakness 18%. Electrodiagnostic study revealed demyelinating process in 54% and axonopathy in 46%. Twenty-nine patients received intravenous immunoglobulin while 13 patients underwent plasmapheresis. Clinical outcomes were satisfactory in most of the patients and only two patients died from sepsis and pneumonia. On discharge, the status of the patients were Hughes grade 1-4 in 73%, 14%, 5%, and 4% respectively. Bulbar paresis as the presenting symptom was the only clinical prognostic factor that significantly determined airway compromised and subsequently respiratory failure.

CONCLUSION

Clinical features of GBS in the present series were characterized by generalized muscle weakness with mild numbness in combination with facial and bulbar paresis in nearly half of patients. Respiratory failure was encountered in 9% of cases. Clinical outcomes were satisfactory in most of the patients with or without specific treatment. The most significant predictor for adverse clinical course was the bulbar paresis as a presenting symptom and patients who presented with less disability score had a better recovery.

背景

吉兰 - 巴雷综合征（GBS）是一种急性、可致命但可治疗的多发性神经根病。在泰国，关于该疾病实体的临床数据稀缺。本研究的目的是描述GBS的临床特征和治疗方法，并确定GBS的预后因素。

材料与方法

通过使用住院患者医院数据库，检索了朱拉隆功国王纪念医院2002 - 2007年期间GBS的临床数据。采用阿斯伯里（Asbury）和科恩布拉思（Cornblath）的标准进行GBS的诊断。收集临床数据、电生理数据、治疗方法及临床预后因素，并使用SPSS 16版软件进行分析。

结果

共纳入55例GBS患者，其中男性26例，女性29例。平均年龄为43±17岁。前驱感染史包括：呼吸道感染29%，胃肠道感染7%，耳部感染2%，非特异性感染14%。初始表现为肢体无力87%，肢体麻木78%，延髓肌无力31%，面部肌无力18%。电诊断研究显示脱髓鞘过程占54%，轴索性病变占46%。29例患者接受了静脉注射免疫球蛋白治疗，13例患者接受了血浆置换。大多数患者的临床结局令人满意，仅有2例患者死于败血症和肺炎。出院时，患者的休斯分级分别为1 - 4级，比例依次为73%、14%、5%和4%。以延髓麻痹作为首发症状是唯一显著决定气道受损及随后呼吸衰竭的临床预后因素。