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老年吉兰-巴雷综合征患者的临床特征及短期预后

The clinical characteristics and short-term prognosis in elderly patients with Guillain-Barré syndrome.

作者信息

Zhang Bing, Wu Xiujuan, Shen Donghui, Li Ting, Li Chunrong, Mao Mei, Zhang Hong-Liang, Liu Kangding

机构信息

Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China.

出版信息

Medicine (Baltimore). 2017 Jan;96(1):e5848. doi: 10.1097/MD.0000000000005848.

Abstract

To investigate the clinical characteristics and short-term prognosis of elderly patients with Guillain-Barré syndrome (GBS).We retrospectively analyzed the clinical data of adult GBS. According to the age, the enrolled subjects were divided into 2 groups, that is, patients ≥60 years (elderly group) and those aged 18 to 59 years (nonelderly group). The clinical characteristics and short-term prognosis of the patients in the 2 groups were compared.In total, 535 patients were enrolled. There were 67 patients fell into the elderly group with a mean age of 69 years old; while 468 patients fell into the nonelderly group with a mean age of 39 years old. We found that the elderly patients had significantly lower incidence of antecedent infections (49.3% vs 66.2%, P < 0.01). The time from onset to admission (5 vs 4 days, P < 0.05) and time from onset to nadir (7 vs 6 days, P < 0.05) were significantly longer in the elderly patients. It was noteworthy that more elderly patients were found with lymphocytopenia (55.4% vs 37.3%, P < 0.01), hyponatremia (25.0% vs 10.2%, P < 0.01), hypoalbuminemia (9.0% vs 2.6%, P < 0.05), and hyperglycemia (34.3% vs 15.2%, P < 0.01). Importantly, the elderly patients had longer duration of hospitalization (17 vs 14 days, P < 0.05), higher incidence of pneumonia (29.9% vs 18.8%, P < 0.05), and poorer short-term prognosis (58.2% vs 42.7%, P < 0.05). In patients with severe GBS, no significant differences were observed in disease severity, treatment modality, incidence of pneumonia, and duration of hospitalization between the 2 groups. However, more patients in the elderly group showed poor short-term prognosis (84.1% vs 63.8%, P < 0.01). Further, old age (≥60 years) (OR = 2.906, 95% CI: 1.174-7.194, P < 0.05) and lower Medical Research Council (MRC) score at nadir (OR = 0.948, 95% CI: 0.927-0.969, P < 0.01) were risk factors for poor short-term prognosis in severe GBS patients.The clinical characteristics and short-term prognosis of elderly patients with GBS are distinct from nonelderly adults. Old age (≥60 years) and lower nadir MRC score serve as predictor for poor short-term prognosis in severe GBS patients.

摘要

为研究老年吉兰 - 巴雷综合征(GBS)患者的临床特征及短期预后。我们回顾性分析了成年GBS患者的临床资料。根据年龄,将纳入的受试者分为2组,即年龄≥60岁的患者(老年组)和年龄在18至59岁的患者(非老年组)。比较两组患者的临床特征及短期预后。

共纳入535例患者。其中67例患者归入老年组,平均年龄69岁;468例患者归入非老年组,平均年龄39岁。我们发现老年患者前驱感染的发生率显著较低(49.3% 对66.2%,P<0.01)。老年患者从发病到入院的时间(5天对4天,P<0.05)以及从发病到病情最低点的时间(7天对6天,P<0.05)显著更长。值得注意的是,老年患者中淋巴细胞减少(55.4% 对37.3%,P<0.01)、低钠血症(25.0% 对10.2%,P<0.01)、低白蛋白血症(9.0% 对2.6%,P<0.05)及高血糖(34.3% 对15.2%,P<0.01)的发生率更高。重要的是,老年患者住院时间更长(17天对14天,P<0.05),肺炎发生率更高(29.9% 对18.8%,P<0.05),短期预后更差(58.2% 对42.7%,P<0.05)。在重症GBS患者中,两组在疾病严重程度、治疗方式、肺炎发生率及住院时间方面未观察到显著差异。然而,老年组更多患者短期预后较差(84.1% 对63.8%,P<0.01)。此外,年龄≥60岁(OR = 2.906,95%CI:1.174 - 7.194,P<0.05)及病情最低点时医学研究委员会(MRC)评分较低(OR = 0.948,95%CI:0.927 - 0.969,P<0.01)是重症GBS患者短期预后不良的危险因素。

GBS老年患者的临床特征及短期预后与非老年成年人不同。年龄≥60岁及病情最低点时较低的MRC评分是重症GBS患者短期预后不良的预测因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/600d/5228707/04355f53f676/medi-96-e5848-g003.jpg

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