Jacobs B C, Rothbarth P H, van der Meché F G, Herbrink P, Schmitz P I, de Klerk M A, van Doorn P A
Department of Neurology, Erasmus University, Rotterdam, The Netherlands.
Neurology. 1998 Oct;51(4):1110-5. doi: 10.1212/wnl.51.4.1110.
To determine which antecedent infections are specifically associated with the Guillain-Barré syndrome (GBS).
Infections with many agents have been reported preceding GBS. Some infections are related to specific clinical and immunologic subgroups in GBS. Most agents were reported in case reports and uncontrolled small series of GBS patients only, and their relation to GBS and its subgroups remains unclear.
A serologic study for 16 infectious agents in 154 GBS patients and 154 sex- and age-matched controls with other neurologic diseases. Acute phase, pretreatment samples were used from clinically well-defined GBS patients. The seasonal distribution of serum sampling in the GBS and control group was the same.
Multivariate analysis showed that in GBS patients, infections with Campylobacter jejuni (32%), cytomegalovirus (13%), and Epstein-Barr virus (10%) were significantly more frequent than in controls. Mycoplasma pneumoniae infections occurred more often in GBS patients (5%) than in controls in univariate analysis. Infections with Haemophilus influenzae (1%), parainfluenza 1 virus (1%), influenza A virus (1%), influenza B virus (1%), adenovirus (1%), herpes simplex virus (1%), and varicella zoster virus (1%) were also demonstrated in GBS patients, but not more frequently than in controls. C. jejuni infections were associated with antibodies to the gangliosides GM1 and GD1b and with a severe pure motor form of GBS. Cytomegalovirus infections were associated with antibodies to the ganglioside GM2 and with severe motor sensory deficits. Other infections were not related to specific antiganglioside antibodies and neurologic patterns.
Recent infections with C. jejuni, cytomegalovirus, Epstein-Barr virus, and M. pneumoniae are specifically related to GBS. The variety of infections may contribute to the clinical and immunologic heterogeneity of GBS.
确定哪些前驱感染与吉兰 - 巴雷综合征（GBS）有特定关联。
已有报道称多种病原体感染先于GBS出现。一些感染与GBS中特定的临床和免疫亚组相关。大多数病原体仅在病例报告和未设对照的GBS患者小样本系列研究中被报道，它们与GBS及其亚组的关系仍不明确。
对154例GBS患者和154例年龄及性别匹配的患有其他神经系统疾病的对照者进行16种感染性病原体的血清学研究。急性期、预处理样本取自临床明确诊断的GBS患者。GBS组和对照组血清采样的季节分布相同。
多变量分析显示，在GBS患者中，空肠弯曲菌感染（32%）、巨细胞病毒感染（13%）和EB病毒感染（10%）显著高于对照组。单变量分析显示，肺炎支原体感染在GBS患者中（5%）比对照组更常见。GBS患者中也发现有流感嗜血杆菌（1%）、副流感病毒1型（1%）、甲型流感病毒（1%）、乙型流感病毒（1%）、腺病毒（1%）、单纯疱疹病毒（1%）和水痘 - 带状疱疹病毒（1%）感染，但并不比对照组更频繁。空肠弯曲菌感染与神经节苷脂GM1和GD1b抗体以及严重的纯运动型GBS相关。巨细胞病毒感染与神经节苷脂GM2抗体以及严重的运动感觉障碍相关。其他感染与特定的抗神经节苷脂抗体和神经学模式无关。
近期空肠弯曲菌、巨细胞病毒、EB病毒和肺炎支原体感染与GBS有特定关联。感染的多样性可能导致GBS临床和免疫的异质性。
