Huang Chuxin, Zhang Yiliu, Deng Shuwen, Ren Yijun, Lu Wei
Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China.
Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China.
Front Neurol. 2020 Nov 6;11:588290. doi: 10.3389/fneur.2020.588290. eCollection 2020.
Guillain-Barré syndrome (GBS) is mainly associated with preceding exposure to an infectious agent, although the precise pathogenic mechanisms and causes remain unknown. Increasing evidence indicates an association between trauma-related factors and GBS. Here, we performed a systematic review, summarized the current scientific literature related to the onset of GBS associated with trauma, and explored the possible pathogenesis. A literature search of various electronic databases was performed up to May 2020 to identify studies reporting diverse trauma-related triggers of GBS. Data were extracted, summarized descriptively, and evaluated with respect to possible mechanisms. In total, 100 publications, including 136 cases and 6 case series involving GBS triggered by injury, surgery, intracranial hemorrhage, and heatstroke, met our eligibility criteria. The median age of the patients was 53 [interquartile range (IQR) 45-63] years, and 72.1% of the patients were male. The median number of days between the trigger to onset of GBS symptoms was 9 (IQR 6.5-13). Overall, 121 patients (89.0%) developed post-injury/surgical GBS, whereas 13 (9.6%) and 2 (1.5%) patients had preexisting spontaneous intracranial hemorrhage and heatstroke, respectively. The main locations of injury or surgeries preceding GBS were the spine and brain. Based on available evidence, we highlight possible mechanisms of GBS induced by these triggers. Moreover, we propose the concept of "trauma-related GBS" as a new research direction, which may help uncover more pathogenic mechanisms than previously considered for typical GBS triggered by infection or vaccination.
吉兰-巴雷综合征（GBS）主要与先前接触感染源有关，尽管确切的致病机制和病因仍不清楚。越来越多的证据表明创伤相关因素与GBS之间存在关联。在此，我们进行了一项系统综述，总结了当前与创伤相关的GBS发病的科学文献，并探讨了可能的发病机制。截至2020年5月，我们对各种电子数据库进行了文献检索，以确定报告GBS各种创伤相关触发因素的研究。提取数据，进行描述性总结，并对可能的机制进行评估。共有100篇出版物符合我们的纳入标准，包括136例病例和6个病例系列，涉及由损伤、手术、颅内出血和中暑引发的GBS。患者的中位年龄为53岁[四分位间距（IQR）45 - 63岁]，72.1%的患者为男性。从触发因素到GBS症状出现的中位天数为9天（IQR 6.5 - 13天）。总体而言，121例患者（89.0%）发生了损伤后/手术后GBS，而分别有13例（9.6%）和2例（1.5%）患者先前存在自发性颅内出血和中暑。GBS之前的损伤或手术主要部位是脊柱和脑部。基于现有证据，我们强调了这些触发因素诱发GBS的可能机制。此外，我们提出“创伤相关GBS”这一概念作为一个新的研究方向，这可能有助于揭示比先前认为的由感染或疫苗接种引发的典型GBS更多的致病机制。
