Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Addenbrooke's Hospital, University of Cambridge, UK.
J Neurol Neurosurg Psychiatry. 2015 Nov;86(11):1196-201. doi: 10.1136/jnnp-2014-309056. Epub 2014 Dec 24.
Evidence for seasonal variation in incidence and subtype of Guillain-Barré syndrome (GBS) is contradictory, but has implications for provision of neurological services and understanding pathogenesis.
We searched PubMed and EMBASE between inception and January 2014, including all studies reporting seasonal incidence of GBS. We included a retrospective cohort study of patients with GBS at the John Radcliffe Hospital, Oxford 2001-2012 and determined the seasonal variation in GBS incidence and length of stay. The incidence rate ratio (IRR) for winter versus summer was pooled across studies by fixed and random effects meta-analysis weighted by inverse variance, stratified by geographical region, infectious prodrome and GBS subtype.
Across 9836 patients from 42 studies there was a 14% increased risk of GBS in winter versus summer (IRR=1.14, 1.02-1.27, p=0.020), with significant heterogeneity between studies (I(2)=77%, p<0.0001), including significant seasonal variation in Oxford (n=140; p=0.037) for winter versus summer (IRR=1.92, 1.18-3.11, p=0.004) but a non-significantly reduced length of stay for winter versus other seasons (15 vs 21 days, p=0.08). Across all studies, there was greater seasonal variation with respiratory prodrome (IRR=3.06, 1.84-5.11, p<0.0001) than diarrhoeal prodrome (IRR=1.10, 0.60-2.00, p=0.76) and a greater incidence in winter in Western countries (IRR=1.28), the Far East (IRR=1.20) and Middle East (IRR=1.12), with a lower incidence in the Indian subcontinent (IRR=0.86) and Latin America (IRR=0.75).
Incidence of GBS was greater in winter than summer, but this was not evident in all geographical regions. This is likely to be related to regional variation in prodromal illnesses.
有关吉兰-巴雷综合征（GBS）发病和亚型的季节性变化的证据相互矛盾，但这对提供神经科服务和了解发病机制具有重要意义。
我们检索了 PubMed 和 EMBASE 自创建以来至 2014 年 1 月的文献，包括所有报告 GBS 季节性发病的研究。我们纳入了 2001 年至 2012 年在牛津约翰拉德克利夫医院就诊的 GBS 患者的回顾性队列研究，并确定了 GBS 发病率和住院时间的季节性变化。采用固定和随机效应荟萃分析，根据地理位置、前驱感染和 GBS 亚型对各研究进行加权，计算冬季与夏季的发病率比值比（IRR）。
在来自 42 项研究的 9836 例患者中，冬季发生 GBS 的风险增加了 14%（IRR=1.14，1.02-1.27，p=0.020），各研究之间存在显著的异质性（I²=77%，p<0.0001），包括牛津（n=140）的季节性变化显著（p=0.037），冬季与夏季相比（IRR=1.92，1.18-3.11，p=0.004），但冬季的住院时间较其他季节（15 天与 21 天，p=0.08）没有显著缩短。在所有研究中，呼吸道前驱感染（IRR=3.06，1.84-5.11，p<0.0001）的季节性变化大于腹泻前驱感染（IRR=1.10，0.60-2.00，p=0.76），西方国家（IRR=1.28）、远东地区（IRR=1.20）和中东地区（IRR=1.12）冬季的发病率更高，而印度次大陆（IRR=0.86）和拉丁美洲（IRR=0.75）的发病率较低。
GBS 的发病率在冬季高于夏季，但并非在所有地理区域都如此。这可能与前驱疾病的区域差异有关。
