van der Pijl Jolanda, Wilmshurst Jo M, van Dijk Monique, Argent Andrew, Booth Jane, Zampoli Marco
Department of Paediatric Surgery and Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Division of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
J Paediatr Child Health. 2018 Mar;54(3):247-253. doi: 10.1111/jpc.13709. Epub 2017 Sep 28.
To describe the causes, clinical presentation and neurological outcome of acute flaccid paralysis in children.
A retrospective study in a tertiary paediatric hospital in South Africa. Data on clinical presentation, respiratory complications and long-term neurological outcomes of children presenting with acute flaccid paralysis were collected. Logistic regression analysis was applied to determine predictors for the need of mechanical ventilation.
The study included 119 patients, 99 of whom had Guillain-Barré syndrome (GBS); 47 patients (39.5%) required mechanical ventilation. Backward logistic regression analysis revealed that bulbar dysfunction (P < 0.001), autonomic dysfunction (P = 0.003) and upper limb paralysis (P = 0.038) significantly predicted the need for mechanical ventilation. EuroQol-5D scores of self-care problems and usual activities after discharge significantly declined over time.
In this large series from Africa, GBS was the main cause of acute flaccid paralysis in children and was associated with significant morbidity. Other causes of acute flaccid paralysis mimicking GBS were not uncommon and should be excluded in this setting.
描述儿童急性弛缓性麻痹的病因、临床表现及神经学转归。
在南非一家三级儿科医院进行的一项回顾性研究。收集了急性弛缓性麻痹患儿的临床表现、呼吸并发症及长期神经学转归的数据。应用逻辑回归分析确定机械通气需求的预测因素。
该研究纳入119例患者，其中99例患有吉兰 - 巴雷综合征（GBS）；47例患者（39.5%）需要机械通气。向后逻辑回归分析显示，延髓功能障碍（P < 0.001）、自主神经功能障碍（P = 0.003）和上肢麻痹（P = 0.038）显著预测了机械通气的需求。出院后自我护理问题和日常活动的欧洲五维健康量表（EuroQol-5D）评分随时间显著下降。
在这个来自非洲的大型系列研究中，GBS是儿童急性弛缓性麻痹的主要病因，且与显著的发病率相关。其他酷似GBS的急性弛缓性麻痹病因并不少见，在此情况下应予以排除。
