格林-巴利综合征伴正常或亢进腱反射。

Guillain-Barré syndrome associated with normal or exaggerated tendon reflexes.

机构信息

Departments of Microbiology and Medicine, National University of Singapore, Block MD4A, Level 5, 5 Science Drive 2, Singapore 117597, Singapore.

出版信息

J Neurol. 2012 Jun;259(6):1181-90. doi: 10.1007/s00415-011-6330-4. Epub 2011 Dec 6.

DOI:10.1007/s00415-011-6330-4

PMID:22143612

Abstract

Areflexia is part one of the clinical criteria required to make a diagnosis of Guillain-Barré syndrome (GBS). The diagnostic criteria were stringently developed to exclude non-GBS cases but there have been reports of patients with GBS following Campylobacter jejuni enteritis with normal and exaggerated deep tendon reflexes (DTRs). The aim of this study is to expand the existing diagnostic criteria to preserved DTRs. From the cohort of patients referred for anti-ganglioside antibody testing from hospitals throughout Japan, 48 GBS patients presented with preserved DTR at admission. Thirty-two patients had normal or exaggerated DTR throughout the course of illness whereas in 16 patients the DTR became absent or diminished during the course of the illness. IgG antibodies against GM1, GM1b, GD1a, or GalNAc-GD1a were frequently present in either group (84 vs. 94%), suggesting a close relationship between the two groups. We then investigated the clinical and laboratory findings of 213 GBS patients from three hospital cohorts. In 23 patients, eight presented with normal tendon reflexes throughout the clinical course of the illness. Twelve showed hyperreflexia, with at least one of the jerks experienced even at nadir, and exaggerated reflexes returning to normal at recovery. The other three had hyperreflexia throughout the disease course. Compared to 190 GBS patients with reduced or absent DTR, the 23 DTR-preserved patients more frequently presented with pure motor limb weakness (87 vs. 47%, p = 0.00026), could walk 5 m independently at the nadir (70 vs. 33%, p = 0.0012), more frequently had antibodies against GM1, GM1b, GD1a, or GalNAc-GD1a (74 vs. 47%, p = 0.014) and were more commonly diagnosed with acute motor axonal neuropathy (65 vs. 34%, p = 0.0075) than with acute inflammatory demyelinating polyneuropathy (13 vs. 43%, p = 0.0011). This study demonstrated that DTRs could be normal or hyperexcitable during the entire clinical course in approximately 10% of GBS patients. This possibility should be added in the diagnostic criteria for GBS to avoid delays in diagnosis and effective treatment to these patients.

摘要

腱反射正常或亢进是吉兰-巴雷综合征（GBS）诊断标准之一。诊断标准是为了严格排除非 GBS 病例而制定的，但已有报道称，一些空肠弯曲菌肠炎后出现 GBS 的患者腱反射正常或亢进。本研究旨在将现有的诊断标准扩展到腱反射保留的病例。从日本各地医院转诊进行神经节苷脂抗体检测的患者队列中，有 48 例 GBS 患者在入院时腱反射保留。32 例患者在整个病程中腱反射正常或亢进，而在 16 例患者中，腱反射在病程中消失或减弱。两组患者均经常出现针对 GM1、GM1b、GD1a 或 GalNAc-GD1a 的 IgG 抗体（84% vs. 94%），表明两组之间存在密切关系。然后，我们研究了来自三个医院队列的 213 例 GBS 患者的临床和实验室发现。在 23 例患者中，有 8 例患者在整个病程中腱反射正常。12 例患者出现反射亢进，至少有一个阵挛在疾病最低点时出现，反射亢进在恢复期恢复正常。另外 3 例患者在整个病程中均出现反射亢进。与 190 例腱反射减弱或消失的 GBS 患者相比，23 例腱反射保留患者更常出现单纯运动性肢体无力（87% vs. 47%，p=0.00026），在最低点时可独立行走 5 米（70% vs. 33%，p=0.0012），更常出现针对 GM1、GM1b、GD1a 或 GalNAc-GD1a 的抗体（74% vs. 47%，p=0.014），更常被诊断为急性运动轴索性神经病（65% vs. 34%，p=0.0075）而不是急性炎症性脱髓鞘性多发性神经病（13% vs. 43%，p=0.0011）。本研究表明，在大约 10%的 GBS 患者中，腱反射在整个临床病程中可能正常或亢进。在 GBS 的诊断标准中应加入这种可能性，以避免对这些患者的诊断和有效治疗延误。