Neuromuscular diseases Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
Neurology Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
Can J Neurol Sci. 2023 Sep;50(5):745-750. doi: 10.1017/cjn.2022.288. Epub 2022 Aug 18.
Half of Guillain-Barré syndrome (GBS) present elevated cerebrospinal fluid (CSF) protein levels within 1 week since symptom onset and 80% within 2 weeks. Our objective was to determine the clinical and prognostic implication of albuminocytological dissociation in early GBS.
An ambispective cohort study was conducted. Good outcome was considered if the patient was able to walk unaided (Guillain-Barré disability score [GDS] ≤ 2 points) at 3-month follow-up. Patients were classified into two groups: with and without albuminocytological dissociation; we compared clinical and paraclinic characteristics between the groups. We analyzed clinical and electrophysiological factors related to presenting early dissociation through a multivariate model.
We included 240 patients who fulfilled Asbury criteria for GBS. On further selection, only 94 patients fulfilled inclusion. Mean age was 45.94 ± 17.1 years and 67% were male. Median time from symptom onset to admission was 5 days (IQR 3-6). Regarding albuminocytological dissociation and electrophysiological variants, we found a significant difference: acute inflammatory demyelinating polyneuropathy (AIDP) [60.6% vs 26.2%, = 0.002], acute motor axonal neuropathy (AMAN) [21.2% vs 49.1%, = 0.009] and acute motor sensory axonal neuropathy (AMSAN) [12.1% vs 1.6%, = 0.05]. We did not observe significant differences in recovery of independent walking in short term between both groups. The presence of conduction block in any variant (OR 3.21, 95% CI 1.12-9.16, = 0.02) and absence of sural registration (OR 5.69, 95% CI 1.48-21.83, = 0.011) were independent factors related to early dissociation.
Early dissociation (<7 days) is not associated with any particular clinical feature or unfavorable outcome. It is more common to see in AIDP rather than axonal variants.
半数吉兰-巴雷综合征（GBS）患者在症状出现后 1 周内出现脑脊液（CSF）蛋白水平升高，80%在 2 周内升高。我们的目的是确定早期 GBS 中白蛋白细胞分离的临床和预后意义。
进行了一项前瞻性队列研究。如果患者在 3 个月随访时能够独立行走（吉兰-巴雷残疾评分[GDS]≤2 分），则认为预后良好。患者分为两组：有和无白蛋白细胞分离；我们比较了两组之间的临床和实验室特征。我们通过多变量模型分析了与早期分离相关的临床和电生理因素。
我们纳入了符合吉兰-巴雷标准的 240 例患者。进一步选择后，仅纳入了 94 例符合纳入标准的患者。平均年龄为 45.94±17.1 岁，67%为男性。从症状出现到入院的中位时间为 5 天（IQR 3-6）。关于白蛋白细胞分离和电生理变异，我们发现有显著差异：急性炎症性脱髓鞘性多发性神经病（AIDP）[60.6%比 26.2%， = 0.002]、急性运动轴索性神经病（AMAN）[21.2%比 49.1%， = 0.009]和急性运动感觉轴索性神经病（AMSAN）[12.1%比 1.6%， = 0.05]。两组患者短期独立行走恢复情况无显著差异。任何变异中存在传导阻滞（OR 3.21，95%CI 1.12-9.16， = 0.02）和不存在腓肠神经记录（OR 5.69，95%CI 1.48-21.83， = 0.011）是与早期分离相关的独立因素。
早期分离（<7 天）与任何特定的临床特征或不良预后无关。它更常见于 AIDP 而不是轴索性变异。
