Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
Muscle Nerve. 2024 Dec;70(6):1215-1222. doi: 10.1002/mus.28271. Epub 2024 Oct 3.
INTRODUCTION/AIMS: Despite treatment, a considerable proportion of patients with Guillain-Barré syndrome (GBS) experience poor recovery, highlighting a therapeutic need. There is a lack of evidence that treatment timing affects recovery. This study aims to investigate the effects of intravenous immunoglobulin (IVIg) timing on disability and speed of recovery in GBS.
We performed a retrospective study of 136 IVIg-treated GBS patients admitted to two Korean centers between 2010 and 2021. We analyzed the effect of time to IVIg on the GBS disability scale (GBS-DS) and the degree of improvement from nadir (∆GBS-DS) at 1, 3, 6, and 12 months, as well as the time to regain the ability to walk or run unaided. Time to IVIg was treated either as a continuous variable or categorized into 1-week intervals to explore critical time windows. Known prognostic factors, the modified Erasmus GBS Outcome Scores on admission and pre-treatment serum albumin levels were adjusted as covariates.
Shorter time to IVIg was independently associated with better GBS-DS, greater ∆GBS-DS, and shorter time to walk or run unaided at all time points. The therapeutic effect of IVIg was notably diminished when administered beyond the first 2 weeks of onset.
Our study highlights the timing of IVIg as a modifiable prognostic factor in GBS. The earlier IVIg is initiated, the better the outcomes, with the ideal time window being within the first 2 weeks. These findings underscore the importance of prompt diagnosis and early intervention to optimize recovery in GBS patients.
简介/目的：尽管进行了治疗，但相当一部分吉兰-巴雷综合征（GBS）患者的恢复情况仍较差，这凸显了治疗的需求。目前缺乏证据表明治疗时机影响恢复。本研究旨在调查静脉注射免疫球蛋白（IVIg）时机对 GBS 患者残疾和恢复速度的影响。
我们对 2010 年至 2021 年间在韩国的两个中心接受 IVIg 治疗的 136 例 GBS 患者进行了回顾性研究。我们分析了 IVIg 时间对 GBS 残疾量表（GBS-DS）和从最低点（∆GBS-DS）开始的 1、3、6 和 12 个月的改善程度以及恢复独立行走或跑步能力的时间的影响。IVIg 时间既被视为连续变量，也被分为 1 周间隔以探索关键的时间窗。将已知的预后因素、入院时改良的 Erasmus GBS 结局评分和治疗前血清白蛋白水平作为协变量进行调整。
IVIg 时间更短与 GBS-DS 更好、∆GBS-DS 更大以及独立行走或跑步能力恢复的时间更短相关。在发病后第 2 周内，IVIg 的治疗效果明显减弱。
本研究强调了 IVIg 时机作为 GBS 的一个可改变的预后因素。IVIg 越早开始，结局越好，理想的时间窗口在发病后的前 2 周内。这些发现强调了及时诊断和早期干预以优化 GBS 患者恢复的重要性。
