Altern Ther Health Med. 2024 Oct;30(10):416-421.
At present, some Guillain-Barre syndrome (GBS) patients have a relatively poor prognosis due to the lack of timely diagnosis, and the risk of death is difficult to reduce. At present, the level of clinical diagnosis of GBS is not ideal, and the time of clinical examination and diagnosis is relatively long. How to improve the level of clinical diagnosis, clinical treatment and prognosis of GBS has always been the focus of clinical research of GBS. This study mainly analyzes the application efficacy of limb peripheral nerve ultrasound in the diagnosis, classification and disease assessment of GBS, hoping to supplement the application research of limb peripheral nerve ultrasound in the diagnosis of GBS and provide some reference for the development of clinical diagnosis of GBS.
To explore the application and value of limb peripheral nerve ultrasound in Guillain-Barre syndrome (GBS).
In this case-control study, 35 GBS patients (GBS group) and 20 healthy volunteers (normal group) were enrolled, the ultrasound features of GBS, NCSA dimensions of limbs, NCSA sizes of limbs in patients with different types of GBS, and NCSA sizes of vagus nerves in patients with different conditions of GBS were clinically detected and collected.Pearson correlation coefficient was used to evaluate the correlation between limb nerve cross-sectional areas (NCSAs) and nerve electrophysiology indexes in GBS patients. The receiver operating characteristic curve (ROC) was adopted to analyze the value of limb NCSAs for diagnosing GBS.
Compared with the normal group, NCSAs of multiple limbs neurodes in the GBS group increased significantly (P < .05). Patients with different GBS classifications had significantly different limb NCSAs in the proximal or distal nerve (P < .05). Compared with patients without autonomic nervous dysfunction, patients combined with autonomic nervous dysfunction had significantly expanded NCSA of the vagus nerve (P < .05). NCSAs of the median nerve and ulnar nerve were negatively correlated with motor nerve conduction velocity (MCV) and positively correlated with compound muscle action potential (CMAP) latency (both P < .05); NCSA of the median nerve showed a negative correlation with sensory nerve conduction velocity (SCV) (P < .05).The ROC curve showed that the auc of ncsa of median nerve (median), ulnar nerve (proximal), vagus nerve, brachial plexus, and common peroneal nerve in the diagnosis of GBS were 0.851, 0.813, 0.783, 0.774, and 0.670, respectively (P < .05), which had diagnostic efficacy. The sensitivity were 85.36%, 80.08%, 78.85%, 76.93% and 70.88%, respectively. The specificity were 68.29%, 73.65%, 78.86%, 80.29% and 83.56%, respectively.
Limbs peripheral nerve ultrasound can effectively assist the early diagnosis, classification, and assessment of the severity of illness of GBS, it has a good diagnostic effect on multi-limb ganglion NCSA and vagus nerve NCSA.In the future, the application of limb peripheral nerve ultrasound in the early diagnosis, classification and severity assessment of GBS can improve the efficacy of clinical diagnosis of GBS and provide a good basis for the improvement of prognosis of GBS.
目前，由于缺乏及时诊断，一些吉兰-巴雷综合征（GBS）患者预后较差，死亡风险难以降低。目前，GBS 的临床诊断水平并不理想，临床检查和诊断的时间相对较长。如何提高 GBS 的临床诊断水平、临床治疗和预后一直是 GBS 临床研究的重点。本研究主要分析四肢周围神经超声在 GBS 的诊断、分型和疾病评估中的应用效果，希望能补充四肢周围神经超声在 GBS 诊断中的应用研究，为 GBS 临床诊断的发展提供一些参考。
探讨四肢周围神经超声在吉兰-巴雷综合征（GBS）中的应用及价值。
采用病例对照研究，纳入 35 例 GBS 患者（GBS 组）和 20 名健康志愿者（正常组），对 GBS 患者进行超声特征、四肢 NCSA 维度、不同类型 GBS 患者的四肢 NCSA 大小、不同病情 GBS 患者的迷走神经 NCSA 大小进行临床检测和采集。采用 Pearson 相关系数评估 GBS 患者四肢神经横截面积（NCSA）与神经电生理指标的相关性。采用受试者工作特征曲线（ROC）分析四肢 NCSA 对 GBS 的诊断价值。
与正常组相比，GBS 组患者四肢多个神经束的 NCSA 明显增加（P<0.05）。不同 GBS 分型患者近端或远端神经的肢体 NCSA 差异有统计学意义（P<0.05）。与无自主神经功能障碍的患者相比，合并自主神经功能障碍的患者迷走神经 NCSA 明显增大（P<0.05）。正中神经和尺神经 NCSA 与运动神经传导速度（MCV）呈负相关，与复合肌肉动作电位（CMAP）潜伏期呈正相关（均 P<0.05）；正中神经 NCSA 与感觉神经传导速度（SCV）呈负相关（P<0.05）。ROC 曲线显示，NCSA 诊断 GBS 的曲线下面积（auc）分别为正中神经（median）、尺神经（近端）、迷走神经、臂丛、腓总神经的 0.851、0.813、0.783、0.774、0.670（P<0.05），均具有诊断效能。敏感度分别为 85.36%、80.08%、78.85%、76.93%、70.88%；特异度分别为 68.29%、73.65%、78.86%、80.29%、83.56%。
四肢周围神经超声能有效辅助 GBS 的早期诊断、分型和病情严重程度评估，对多肢神经节 NCSA 和迷走神经 NCSA 具有良好的诊断效果。未来，四肢周围神经超声在 GBS 的早期诊断、分型和严重程度评估中的应用，有望提高 GBS 临床诊断的疗效，为 GBS 预后的改善提供良好的依据。
