国际视角下吉兰-巴雷综合征的前驱感染：IGOS-1000 队列研究。
An International Perspective on Preceding Infections in Guillain-Barré Syndrome: The IGOS-1000 Cohort.
机构信息
From the Departments of Neurology (S.E.L., S. Arends, B.v.d.B., A.Y.D., P.A.v.D., K.K., L.W.G.L., W.V.R., J.R., C.V., B.C.J.), and Viroscience (A.A.v.d.E.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (H.A., T.H.), Aarhus University Hospital, Denmark; Department of Neurology (G.A.), Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, University of Rome "Sapienza," Sant' Andrea Hospital, Italy; Department of Neurology (S. Arends), Haga Teaching Hospital, The Hague, the Netherlands; Department of Neurology (S. Attarian), Reference Centre for NMD, CHU Timone, Marseille, France; Department of Neurology (F.A.B.), Instituto de Investigaciones Neurológicas Raúl Carrea, FLENI, Buenos Aires, Argentina; Division of Neurology (K.J.B., E.L.P.), Department of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa; Department RH-MDC-Immunology (M.R.B., M.M.), Reinier de Graaf Gasthuis, Delft, the Netherlands; Department of Neurology (L.B.), IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neurology (B.v.d.B., F.H.V.), Franciscus Gasthuis & Vlietland, Schiedam, the Netherlands; Department of Neurology (P.V.d.B.), University Hospital St. Luc, University of Louvain, Brussels, Belgium; Department of Neurology (J.B.), Saarland University Medical School, Homburg (previous hospital), and MVZ Pfalzklinikum (J.B.), Kusel, Germany (current hospital); Department of Neurology (M.B.), Leeds Teaching Hospitals, United Kingdom; Department of Neurology (C.C., V.N.-H.), Neuromuscular Unit, Bellvitge University Hospital-IDIBELL, CIBERER, Barcelona, Spain; Department of Neurology (D.R.C.), Johns Hopkins University, Baltimore, MD; Institute of Infection, Immunity and Inflammation (A.D., H.J.W.), University of Glasgow, United Kingdom; National Hospital Copenhagen (C.D.d.l.C.), Copenhagen, Denmark; Department of Clinical Neurosciences (T.E.F.), University of Calgary, Alberta, Canada; Nuffield Department of Clinical Neurosciences (J.F., S.R.), University of Oxford, John Radcliffe Hospital, United Kingdom; Department of Neurology (T.G.-S., J.P.), Hospital Clínico de Santiago, Spain; Neurology, Neuromuscular Diseases, Electromyography (J.M.G.), Hospital for Special Surgery; Weill Medical College of Cornell University (J.M.G.), New York; Department of Neurology (K.C.G., B.S.), Tufts University School of Medicine, Boston, MA; Department of Neurology (V.G.), Montefiore Medical Center, New York; Department of Neurology (R.D.M.H.), King's College Hospital, London, United Kingdom; Department of Neurology (H.-P.H.), University of Düsseldorf, Germany; Brain and Mind Centre (H.-P.H.), University of Sydney, Australia; Department of Neurology (H.-P.H.), Medical University of Vienna, Austria; Laboratory of Gut-Brain Signaling (I.H., I.J., Z.I., Q.D.M.), Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh; Department of Neurology (J.V.H., S.H.S.), Odense University Hospital, Denmark; Department of Neurology (J.K.L.H.), The Walton Centre, Liverpool, United Kingdom; Department of Neurology (S. Karafiath), Utah Valley University, Orem; Department of Neurology (H.D.K.), University Health Network, University of Toronto, ON, Canada; Department of Neurology (R.P.K., K.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (N.K.), University of Vermont Medical Centre, Burlington; Department of Neurology (M.K., S. Kusunoki), Kindai University, Faculty of Medicine, Osaka, Japan; Department of Neurology (L.W.G.L., L.H.V.), St. Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (S. Kuwabara), Chiba University, Japan; Department of Neurology (H.C.L.), University Hospital of Cologne, Germany; Department of Neurology (L.M.-A., L.Q.), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain; Department of Neurology (J.A.L.M.), Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom; Department of Neurology (S.M.), Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina; Neuromuscular and Neuroimmunology Service (E.N.-O.), IRCCS Humanitas Research Hospital, Milan University, Italy; Department of Clinical Neurophysiology (Y.P.), Reference Centre for NMD, CHU Nantes, France; Department of Neurology (R.R.), Hospital Británico, Buenos Aires, Argentina; Department of Immunology (W.V.R., A.P.T.-G., R.H., B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (S.R.), Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital; Department of Neurology (R.C.R.), Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, United Kingdom; Department of Medicine (N.S., T.C.-Y.), University of Malaya, Kuala Lumpur; Department of Neurology (S.H.S.), University of Southern Denmark, Odense; Department of Clinical Neurophysiology (H.T.), Aarhus University Hospital, Denmark; and Hospital Universitario Marques de Valdecilla (M.J.S.T.), Santander, Cantabria, Spain.
出版信息
Neurology. 2022 Sep 20;99(12):e1299-e1313. doi: 10.1212/WNL.0000000000200885. Epub 2022 Aug 18.
BACKGROUND AND OBJECTIVES
Infections play a key role in the development of Guillain-Barré syndrome (GBS) and have been associated with specific clinical features and disease severity. The clinical variation of GBS across geographical regions has been suggested to be related to differences in the distribution of preceding infections, but this has not been studied on a large scale.
METHODS
We analyzed the first 1,000 patients included in the International GBS Outcome Study with available biosamples (n = 768) for the presence of a recent infection with , hepatitis E virus, , cytomegalovirus, and Epstein-Barr virus.
RESULTS
Serologic evidence of a recent infection with was found in 228 (30%), in 77 (10%), hepatitis E virus in 23 (3%), cytomegalovirus in 30 (4%), and Epstein-Barr virus in 7 (1%) patients. Evidence of more than 1 recent infection was found in 49 (6%) of these patients. Symptoms of antecedent infections were reported in 556 patients (72%), and this proportion did not significantly differ between those testing positive or negative for a recent infection. The proportions of infections were similar across continents. The sensorimotor variant and the demyelinating electrophysiologic subtype were most frequent across all infection groups, although proportions were significantly higher in patients with a cytomegalovirus and significantly lower in those with a infection. -positive patients were more severely affected, indicated by a lower Medical Research Council sum score at nadir ( = 0.004) and a longer time to regain the ability to walk independently ( = 0.005). The pure motor variant and axonal electrophysiologic subtype were more frequent in Asian compared with American or European -positive patients ( < 0.001, resp. = 0.001). Time to nadir was longer in the cytomegalovirus-positive patients ( = 0.004).
DISCUSSION
Across geographical regions, the distribution of infections was similar, but the association between infection and clinical phenotype differed. A mismatch between symptom reporting and serologic results and the high frequency of coinfections demonstrate the importance of broad serologic testing in identifying the most likely infectious trigger. The association between infections and outcome indicates their value for future prognostic models.
背景与目的
感染在吉兰-巴雷综合征（GBS）的发展中起着关键作用，并且与特定的临床特征和疾病严重程度相关。GBS 在不同地理区域的临床表现差异被认为与先前感染的分布差异有关，但尚未在大规模研究中进行研究。
方法
我们分析了国际 GBS 结局研究中纳入的前 1000 例患者中（n = 768）的可用生物样本，以确定是否存在近期感染、戊型肝炎病毒、细小病毒 B19、巨细胞病毒和 EB 病毒。
结果
228 例（30%）、77 例（10%）、23 例（3%）、30 例（4%）和 7 例（1%）患者血清学证据显示存在近期感染、戊型肝炎病毒、细小病毒 B19、巨细胞病毒和 EB 病毒。这些患者中有 49 例（6%）存在不止一种近期感染的证据。556 例患者（72%）报告有前驱感染症状，但在感染阳性和阴性患者中，这一比例没有显著差异。在所有感染组中，感觉运动变异型和脱髓鞘电生理亚型最为常见，尽管在巨细胞病毒感染组中比例显著更高，而在 感染组中比例显著更低。感染阳性患者的病情更为严重，表现在最低时的医学研究委员会总分较低（= 0.004），并且恢复独立行走能力的时间较长（= 0.005）。与美洲或欧洲感染阳性患者相比，亚洲感染阳性患者更常见纯运动变异型和轴索性电生理亚型（< 0.001，分别为= 0.001）。巨细胞病毒感染阳性患者的时间到最低时更长（= 0.004）。
讨论
在不同的地理区域，感染的分布相似，但感染与临床表型之间的关联不同。症状报告和血清学结果之间的不匹配以及合并感染的高频率表明广泛的血清学检测对于确定最可能的感染触发因素非常重要。感染与结局之间的关联表明它们对未来预后模型的价值。
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