Michel-Chávez Anaclara, Chiquete Erwin, Gulías-Herrero Alfonso, Carrillo-Pérez Diego Luis, Olivas-Martínez Antonio, Macías-Gallardo Julio, Aceves-Buendía José de Jesús, Ruiz-Ruiz Eduardo, Bliskunova Tatiana, Portillo-Valle Jennefer, Cobilt-Catana Rafael, Ortiz-Quezada Jorge Alberto, Durán-Coyote Salvador, Rodríguez-Perea Elizabeth, Aguilar-Salas Emmanuel, Cantú-Brito Carlos, García-Ramos Guillermo, Estañol Bruno
Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Can J Neurol Sci. 2023 Mar;50(2):221-227. doi: 10.1017/cjn.2022.19. Epub 2022 Feb 22.
The early clinical predictors of respiratory failure in Latin Americans with Guillain-Barré syndrome (GBS) have scarcely been studied. This is of particular importance since Latin America has a high frequency of axonal GBS variants that may imply a worse prognosis.
We studied 86 Mexican patients with GBS admitted to the , a referral center of Mexico City, to describe predictors of invasive mechanical ventilation (IMV).
The median age was 40 years (interquartile range: 26-53.5), with 60.5% men (male-to-female ratio: 1.53). Most patients (65%) had an infectious antecedent (40.6% gastrointestinal). At admission, 38% of patients had a Medical Research Council (MRC) sum score <30. Axonal subtypes predominated (60.5%), with acute motor axonal neuropathy being the most prevalent (34.9%), followed by acute inflammatory demyelinating polyneuropathy (32.6%), acute motor sensory axonal neuropathy (AMSAN) (25.6%), and Fisher syndrome (7%). Notably, 15.1% had onset in upper limbs, 75.6% dysautonomia, and 73.3% pain. In all, 86% received either IVIg (9.3%) or plasma exchange (74.4%). IMV was required in 39.5% patients (72.7% in AMSAN). A multivariate model without including published prognostic scores yielded the time since onset to admission <15 days, axonal variants, MRC sum score <30, and bulbar weakness as independent predictors of IMV. The model including grading scales yielded lower limbs onset, Erasmus GBS respiratory insufficiency score (EGRIS) >4, and dysautonomia as predictors.
These results suggest that EGRIS is a good prognosticator of IMV in GBS patients with a predominance of axonal electrophysiological subtypes, but other early clinical data should also be considered.
拉丁美洲格林-巴利综合征（GBS）患者呼吸衰竭的早期临床预测因素鲜有研究。鉴于拉丁美洲轴索性GBS变异型的高发病率可能意味着更差的预后，这一点尤为重要。
我们研究了86例入住墨西哥城一家转诊中心的墨西哥GBS患者，以描述有创机械通气（IMV）的预测因素。
中位年龄为40岁（四分位间距：26 - 53.5），男性占60.5%（男女比例：1.53）。大多数患者（65%）有前驱感染史（40.6%为胃肠道感染）。入院时，38%的患者医学研究委员会（MRC）总分<30。轴索亚型占主导（60.5%），急性运动轴索性神经病最为常见（34.9%），其次是急性炎症性脱髓鞘性多发性神经病（32.6%）、急性运动感觉轴索性神经病（AMSAN）（25.6%）和费舍尔综合征（7%）。值得注意的是，15.1%的患者起病于上肢，75.6%有自主神经功能障碍，73.3%有疼痛。总共86%的患者接受了静脉注射免疫球蛋白（IVIg）（9.3%）或血浆置换（74.4%）。39.5%的患者需要IMV（AMSAN患者中为72.7%）。一个未纳入已发表预后评分的多变量模型得出，起病至入院时间<15天、轴索变异型、MRC总分<30和延髓肌无力是IMV的独立预测因素。纳入分级量表的模型得出下肢起病、伊拉斯姆斯GBS呼吸功能不全评分（EGRIS）>4和自主神经功能障碍是预测因素。
这些结果表明，对于以轴索性电生理亚型为主的GBS患者，EGRIS是IMV的良好预后指标，但也应考虑其他早期临床数据。
