Wu Xiujuan, Shen Donghui, Li Ting, Zhang Bing, Li Chunrong, Mao Mei, Zhao Jixue, Liu Kangding, Zhang Hong-Liang
Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China.
Department of Pediatric Surgery, the First Hospital of Jilin University, Jilin University, Changchun, China.
PLoS One. 2016 Mar 14;11(3):e0151611. doi: 10.1371/journal.pone.0151611. eCollection 2016.
Clinical characteristics of pediatric Guillain-Barré syndrome (GBS) have been extensively studied whereas scarcely been compared with those of adult GBS. Herein we compared the clinical features of GBS between pediatric and adult patients.
We retrospectively collected the clinical data of 750 patients with GBS (541 adults and 209 children), and compared the clinical characteristics between children and adults.
Pain was a more frequent complaint in children (17.2% vs 9.6%, p < 0.01), who were also found with shorter interval from disease onset to nadir (6.3d vs 7.3d, p < 0.01) and higher incidence of bulbar dysfunction (22.0% vs 14.8%, p < 0.05). The disease severity in children was comparable with adults. In addition, a higher incidence of pediatric GBS was found in summer, especially in July and August (both p < 0.01). However, the incidence of antecedent infections of different seasons in adult and pediatric patients was comparable (p > 0.05). The clinical features of acute motor axonal neuropathy (AMAN) and acute inflammatory demyelinating polyneuropathy (AIDP) in children were overall comparable with adult ones (p > 0.05). Similar to adults, bulbar dysfunction (odds ratio [OR]: 4.621, 95% confidence interval [CI]: 1.240-17.218, p < 0.05) and lower nadir Medical Research Council (MRC) sum score (OR: 0.897, 95% CI: 0.855-0.941, p < 0.01) were also risk factors for mechanical ventilation in children. However, distinct from adult ones, autonomic dysfunction was significantly higher in mechanically ventilated childhood GBS (39.1% vs 8.8%, p < 0.01), which also served as a predictor for mechanical ventilation in pediatric GBS (OR: 70.415, 95% CI: 9.265-535.158, p < 0.01). As to the efficacy of intravenous immunoglobulin, insignificant difference was identified between children and adults.
The clinical features of pediatric GBS differ from those of adults. Autonomic dysfunction is an independent risk factor for mechanical ventilation in pediatric patients.
小儿吉兰 - 巴雷综合征（GBS）的临床特征已得到广泛研究，但很少与成人GBS进行比较。在此，我们比较了小儿和成人GBS患者的临床特征。
我们回顾性收集了750例GBS患者（541例成人和209例儿童）的临床资料，并比较了儿童和成人的临床特征。
疼痛在儿童中更为常见（17.2%对9.6%，p<0.01），儿童从发病到病情最低点的间隔时间也更短（6.3天对7.3天，p<0.01），且延髓功能障碍的发生率更高（22.0%对14.8%，p<0.05）。儿童的疾病严重程度与成人相当。此外，小儿GBS在夏季的发病率较高，尤其是在7月和8月（均p<0.01）。然而，成人和小儿患者不同季节前驱感染的发生率相当（p>0.05）。儿童急性运动轴索性神经病（AMAN）和急性炎症性脱髓鞘性多发性神经病（AIDP）的临床特征总体上与成人相似（p>0.05）。与成人相似，延髓功能障碍（优势比[OR]：4.621，95%置信区间[CI]：1.240 - 17.218，p<0.05）和较低的最低点医学研究委员会（MRC）总分（OR：0.897，95%CI：0.855 - 0.941，p<0.01）也是儿童机械通气的危险因素。然而，与成人不同的是，机械通气的儿童GBS患者自主神经功能障碍明显更高（39.1%对8.8%，p<0.01），这也是小儿GBS机械通气的一个预测因素（OR：70.415，95%CI：9.265 - 535.158，p<0.01）。关于静脉注射免疫球蛋白的疗效，儿童和成人之间未发现显著差异。
小儿GBS的临床特征与成人不同。自主神经功能障碍是小儿患者机械通气的独立危险因素。
