中国南方的吉兰-巴雷综合征：对淮河以南 14 个省份住院患者的回顾性分析。
Guillain-Barré syndrome in southern China: retrospective analysis of hospitalised patients from 14 provinces in the area south of the Huaihe River.
机构信息
Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
出版信息
J Neurol Neurosurg Psychiatry. 2018 Jun;89(6):618-626. doi: 10.1136/jnnp-2017-316930. Epub 2018 Jan 11.
OBJECTIVES
The clinical and epidemiological profiles of Guillain-Barré syndrome (GBS) in southern China have yet to be fully recognised. We aimed to investigate the subtypes of GBS in southern China, compare the clinical features of demyelinating form with that of axonal form and test whether preceding infections and age have influence on the clinical phenotype, disease course and severity of GBS.
METHODS
Medical records of patients with a diagnosis of GBS admitted to 31 tertiary hospitals, located in 14 provinces in southern China, from 1 January 2013 to 30 September 2016, were collected and retrospectively reviewed.
RESULTS
Finally. 1056 patients, including 887 classic GBS and 169 variants, were enrolled. The 661 classic patients with available electromyographic data were grouped as having acute inflammatory demyelinating polyneuropathy (AIDP, 49.0%), acute motor axonal neuropathy (AMAN, 18.8%), inexcitable (0.9%) and equivocal (31.3%). In contrast to AIDP, patients with AMAN were characterised by earlier nadir (P=0.000), higher Hughes score at nadir (P=0.003) and at discharge (P=0.000). Preceding upper respiratory infections were identified in 369 (34.9%) patients, who were more inclined to develop AIDP (P0.000) and Miller-Fisher syndrome (P0.027), whereas gastrointestinal infection were found in 89 (8.4%) patients, who were more prone to develop AMAN (P=0.000), with more severe illness (P=0.001) and longer hospital stay (P=0.009). Children (≤15 years) and the elderly (≥56 years) were more severe at nadir, the elderly had the longest hospital stay (P=0.023).
CONCLUSION
AIDP is the predominant form in southern China, which is different from data of northern China. The different subtypes, preceding infection and age of onset can partially determine the disease progression, severity and short-term recovery speed of GBS.
CLINICAL TRIAL REGISTRATION
ChiCTR-RRC-17014152.
目的
中国南方地区吉兰-巴雷综合征（GBS）的临床和流行病学特征尚未完全明确。本研究旨在探讨中国南方地区 GBS 的亚型，比较脱髓鞘型与轴索性的临床特征，并探讨既往感染和年龄对 GBS 临床表型、病程和严重程度的影响。
方法
收集 2013 年 1 月 1 日至 2016 年 9 月 30 日期间，中国南方 14 个省的 31 家三级医院住院诊断为 GBS 的患者的病历，并进行回顾性分析。
结果
最终纳入 1056 例患者，包括 887 例经典 GBS 和 169 例变异型，其中 661 例有可用的肌电图数据的经典 GBS 患者分为急性炎症性脱髓鞘性多发性神经病（AIDP，49.0%）、急性运动轴索性神经病（AMAN，18.8%）、不可兴奋型（0.9%）和不确定型（31.3%）。与 AIDP 相比，AMAN 患者的神经电生理检查的神经轴索损害更明显，疾病的严重程度更高，且疾病的早期严重程度更重，如神经电生理检查的神经轴索损害更明显（最低值时，P=0.000）、Hughes 评分更低（最低值时，P=0.003；出院时，P=0.000）。369 例（34.9%）患者有前驱上呼吸道感染，前驱上呼吸道感染患者更倾向于发展为 AIDP（P0.000）和 Miller-Fisher 综合征（P0.027），而 89 例（8.4%）患者有前驱胃肠道感染，前驱胃肠道感染患者更易发展为 AMAN（P=0.000），病情更严重（P=0.001），住院时间更长（P=0.009）。儿童（≤15 岁）和老年人（≥56 岁）在疾病的早期严重程度更高，住院时间更长（P=0.023）。
结论
AIDP 是中国南方地区的主要类型，与北方地区的数据不同。不同的亚型、前驱感染和发病年龄可部分决定 GBS 的疾病进展、严重程度和短期恢复速度。
临床试验注册
ChiCTR-RRC-17014152。
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