Ishaque Tanveen, Islam Mohammad B, Ara Gulshan, Endtz Hubert P, Mohammad Quazi D, Jacobs Bart C, Islam Zhahirul
Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Dhaka, Bangladesh.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Peripher Nerv Syst. 2017 Jun;22(2):121-126. doi: 10.1111/jns.12215.
Although Guillain-Barré syndrome (GBS) has higher incidence and poor outcome in Bangladesh, mortality from GBS in Bangladesh has never been explored before. We sought to explore the frequency, timing, and risk factors for deaths from GBS in Bangladesh. We conducted a prospective study on 407 GBS patients who were admitted to Dhaka Medical College Hospital, Dhaka, Bangladesh from 2010 to 2013. We compared deceased and alive patients to identify risk factors. Cox regression model was used to adjust for confounders. Of the 407 GBS patients, 50 (12%) died, with the median time interval between the onset of weakness and death of 18 days. Among the fatal cases, 24 (48%) were ≥40 years, 36 (72%) had a Medical Research Council sum score ≤20 at entry, 33 (66%) had a progressive phase <8 days, and 27 (54%) required ventilation support. Ten patients (20%) died due to unavailability of ventilator. The strongest risk factor for deaths was lack of ventilator support when it was required (HR: 11.9; 95% confidence interval [CI]: 4.6-30.7). Other risk factors for death included age ≥40 years (HR: 5.9; 95% CI: 2.1-16.7), mechanical ventilation (HR: 2.3; 95% CI: 1.02-5.2), longer progressive phase (>8 days) (HR: 2.06; 95% CI: 1.1-3.8), autonomic dysfunction (HR: 1.9; 95% CI: 1.05-3.6), and bulbar nerve involvement (HR: 5.4; 95% CI: 1.5-19.2). In Bangladesh, GBS is associated with higher mortality rates, which is related to lack of ventilator support, disease severity, longer progressive phase of the disease, autonomic dysfunction, and involvement of the bulbar nerves.
尽管吉兰 - 巴雷综合征（GBS）在孟加拉国的发病率较高且预后较差，但此前从未对该国GBS的死亡率进行过研究。我们试图探究孟加拉国GBS死亡的频率、时间及危险因素。我们对2010年至2013年期间入住孟加拉国达卡达卡医学院医院的407例GBS患者进行了一项前瞻性研究。我们比较了死亡患者和存活患者以确定危险因素。采用Cox回归模型对混杂因素进行校正。在407例GBS患者中，50例（12%）死亡，肌无力发作至死亡的中位时间间隔为18天。在致命病例中，24例（48%）年龄≥40岁，36例（72%）入院时医学研究委员会总评分≤20，33例（66%）进展期<8天，27例（54%）需要通气支持。10例患者（20%）因无法获得呼吸机而死亡。死亡的最强危险因素是需要时缺乏通气支持（HR：11.9；95%置信区间[CI]：4.6 - 30.7）。其他死亡危险因素包括年龄≥40岁（HR：5.9；95%CI：2.1 - 16.7）、机械通气（HR：2.3；95%CI：1.02 - 5.2）、较长的进展期（>8天）（HR：2.06；95%CI：1.1 - 3.8）、自主神经功能障碍（HR：1.9；95%CI：1.05 - 3.6）和延髓神经受累（HR：5.4；95%CI：1.5 - 19.2）。在孟加拉国，GBS与较高的死亡率相关，这与缺乏通气支持、疾病严重程度、疾病较长的进展期、自主神经功能障碍以及延髓神经受累有关。
