Visser L H, van der Meché F G, Meulstee J, van Doorn P A
Department of Neurology, Erasmus Medical Center Rotterdam, The Netherlands.
J Neurol Neurosurg Psychiatry. 1998 Feb;64(2):242-4. doi: 10.1136/jnnp.64.2.242.
The risk factors for treatment related clinical fluctuations, relapses occurring after initial therapeutic induced stabilisation or improvement, were evaluated in a group of 172 patients with Guillain-Barré syndrome. Clinical, laboratory, and electrodiagnostic features of all 16 patients with Guillain-Barré syndrome with treatment related fluctuations, of whom 13 were retreated, were compared with those who did not have fluctuations. No significant differences were found between patients with Guillain-Barré syndrome treated with plasma exchange and patients treated with intravenous immune globulins either alone or in combination with high dose methylprednisolone. None of the patients with Guillain-Barré syndrome with preceding gastrointestinal illness, initial predominant distal weakness, acute motor neuropathy, or anti-GM1 antibodies showed treatment related fluctuations. On the other hand patients with fluctuations showed a trend to have the fluctuations after a protracted disease course. It is therefore suggested that treatment related clinical fluctuations are due to a more prolonged immune attack. There is no indication that the fluctuations are related to treatment modality. The results of this study may help the neurologist to identify patients with Guillain-Barré syndrome who are at risk for treatment related fluctuations.
在一组172例吉兰-巴雷综合征患者中，评估了与治疗相关的临床波动风险因素，即初始治疗诱导病情稳定或改善后出现的复发情况。将16例出现与治疗相关波动的吉兰-巴雷综合征患者（其中13例接受了再次治疗）的临床、实验室和电诊断特征与未出现波动的患者进行了比较。接受血浆置换治疗的吉兰-巴雷综合征患者与单独接受静脉注射免疫球蛋白或联合大剂量甲基强的松龙治疗的患者之间未发现显著差异。既往有胃肠道疾病、初始以远端肌无力为主、急性运动神经病或抗GM1抗体的吉兰-巴雷综合征患者均未出现与治疗相关的波动。另一方面，出现波动的患者在病程延长后有出现波动的趋势。因此，提示与治疗相关的临床波动是由于免疫攻击持续时间更长。没有迹象表明波动与治疗方式有关。本研究结果可能有助于神经科医生识别有与治疗相关波动风险的吉兰-巴雷综合征患者。
