Liu Li, Ye Yuqin, Wang Lijuan, Song Xiaonan, Cao Jie, Qi Yajie, Xing Yingqi
Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China.
Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
Muscle Nerve. 2021 Nov;64(5):560-566. doi: 10.1002/mus.27386. Epub 2021 Aug 21.
INTRODUCTION/AIMS: Ultrasound (US) studies have demonstrated patchy enlargement of spinal and peripheral nerves in Guillain-Barré syndrome (GBS). However, whether ultrasound yields useful information for early classification of GBS has not been established. We aimed to evaluate nerve ultrasound in patients with GBS in northern China and compare the sonographic characteristics between demyelinating and axonal subtypes.
Between November 2018 and October 2019, 38 hospitalized GBS patients within 3 wk of disease onset and 40 healthy controls were enrolled. Ultrasonographic cross-sectional areas (CSA) of the peripheral nerves, vagus nerve, and cervical nerve roots were prospectively recorded in GBS subtypes and controls.
Ultrasonographic CSA exhibited significant enlargement in most patients' nerves compared with healthy controls, most prominent in cervical nerves. The CSA tended to be larger in acute inflammatory demyelinating polyneuropathy (AIDP) than in acute motor axonal neuropathy (AMAN)/acute motor and sensory axonal neuropathy (AMSAN), especially in cervical nerves (C5: 5.9 ± 1.6 mm vs. 7.0 ± 1.7 mm , p = .042; C6: 10.5 ± 1.8 mm vs. 12.0 ± 2.1 mm , p = .033). The chi-squared test revealed significant differences in nerve enlargement in C5 (p < .001), C6 (p < .001), the proximal median nerve (p < .001), and the vagus nerve (p = .003) between GBS and controls. The vagus nerve was larger in patients with autonomic dysfunction than in patients without it (2.3 ± 1.0 mm vs. 1.4 ± 0.5 mm , p = .003).
The demyelinating subtype presented with more significant cervical nerve enlargement in GBS. Vagus nerve enlargement may be a useful marker for autonomic dysfunction.
引言/目的：超声（US）研究已证实在吉兰-巴雷综合征（GBS）中脊髓和周围神经呈斑片状增粗。然而，超声能否为GBS的早期分类提供有用信息尚未明确。我们旨在评估中国北方GBS患者的神经超声情况，并比较脱髓鞘型和轴索性亚型之间的超声特征。
在2018年11月至2019年10月期间，纳入38例发病3周内住院的GBS患者和40例健康对照。前瞻性记录GBS各亚型患者及对照者周围神经、迷走神经和颈神经根的超声横截面积（CSA）。
与健康对照相比，大多数GBS患者神经的超声CSA显著增粗，以颈神经最为明显。急性炎症性脱髓鞘性多发性神经病（AIDP）的CSA往往大于急性运动轴索性神经病（AMAN）/急性运动和感觉轴索性神经病（AMSAN），尤其是颈神经（C5：5.9±1.6mm对7.0±1.7mm，p = 0.042；C6：10.5±1.8mm对12.0±2.1mm，p = 0.033）。卡方检验显示GBS组与对照组在C5（p＜0.001）、C6（p＜0.001）、正中神经近端（p＜0.001）和迷走神经（p = 0.003）的神经增粗方面存在显著差异。有自主神经功能障碍的患者迷走神经比无自主神经功能障碍的患者更大（2.3±1.0mm对1.4±0.5mm，p = 0.003）。
在GBS中，脱髓鞘型表现为颈神经增粗更明显。迷走神经增粗可能是自主神经功能障碍的一个有用标志物。
