长春局部地区群发与散发吉兰—巴雷综合征免疫学检测及临床对照研究

发布时间：2018-05-29 01:12

本文选题：吉兰-巴雷综合征 + 临床特征　；参考：《吉林大学》2014年硕士论文

【摘要】：背景及目的：吉兰-巴雷综合征（Guillain-Barré Syndrome，，GBS）多以散发为主，2007年6月～7月发生在长春市双阳地区的36例GBS患者属于区域性暴发流行。GBS发病机制目前尚不明确，大部分学者认为神经节苷脂（Ganglioside，GS）抗体与GBS的发生有关，GBS患者体内可检测到相应抗体水平升高，不同的GS抗体与GBS的临床分型有关，但群发与散发GBS患者体内抗体水平是否存在差异国内外未见报道。本文主要通过ELISA方法检测群发与散发GBS血清和脑脊液GM1、GT1a抗体来比较两者抗体水平是否存在差异，并分析抗体水平与临床表现之间的关系。研究方法：长春市双阳地区临床资料、血清及脑脊液标本保留的15例患者作为群发GBS组、2012.4～2012.10在吉林大学第一医院住院的20例患者作为散发GBS组，同时选取2012.6～2013.1以头痛为主要症状，经腰穿检查脑脊液常规、生化、肝功正常且乙肝抗原、梅毒抗体阴性的20例患者作为正常对照组。应用ELISA方法检测三组间血清和脑脊液GM1和GT1a抗体的含量，并应用SPSS软件对性别、年龄、前驱史、临床特征、电生理表现以及血清和脑脊液GM1和GT1a抗体的含量等因素在群发组和散发组GBS间进行分析比较。研究结果：（1）两组发病率均男性高于女性；发病年龄以20～40岁多见；主要表现为四肢无力；颅神经损害主要出现复视、面瘫及吞咽困难；电生理表现以轴索损伤为主。（2）两组的前驱感染史消化道和呼吸道有统计学差异，群发组以消化道感染（P=0.008)为主，散发组以呼吸道感染（P=0.026）为主。（3）群发组和散发组患者的血清和脑脊液GM1和GT1a抗体水平较正常对照组显著升高，具有显著性差异（P＜0.01），但抗体水平在两组之间无明显差异（P＞0.05）。（4）伴球麻痹的GBS患者血清和脑脊液GT1a抗体水平高于无球麻痹症状患者，具有显著性差异（P＜0.05）。（5）电生理表现以脱髓鞘合并轴索损害为主的患者血清和脑脊液GM1抗体水平最高，其次为单纯轴索损伤，单纯脱髓鞘损伤者抗体水平最低，但三组之间无统计学意义（P＞0.05）。（6）Hughes评分4～6分患者的血清和脑脊液GM1和GT1a抗体水平高于1～3分的患者，但两者之间无统计学差异（P＞0.05）。研究结论：（1）群发组以消化道感染为主，散发组以呼吸道感染为主。（2）群发组和散发组GM1和GT1a抗体水平均高于正常组，但两组间没有统计学差异，提示两组病理生理过程相同。（3）GT1a抗体水平升高可能与球麻痹有关。（4）GM1抗体水平与GBS的电生理改变可能有关，电生理改变越重抗体滴度越高，希望未来扩大样本量进一步验证。
[Abstract]:Background and objective: Guillain-Barr 茅 Syndromefus GBS is mainly sporadic. From June to July 2007, 36 cases of GBS in Shuangyang area of Changchun City belong to regional outbreak. The pathogenesis of GBS is still unclear. Most scholars believe that Ganglioside GBS antibody is related to the occurrence of GBS, and the corresponding antibody level can be detected in patients with GBS. Different GS antibodies are related to the clinical classification of GBS. However, there are no reports on the difference of antibody levels between patients with GBS and those with sporadic GBS at home and abroad. In this paper, ELISA method was used to detect the GM1G 1a antibody in GBS serum and cerebrospinal fluid (CSF), and the relationship between the antibody level and clinical manifestation was analyzed. Methods: the clinical data of Shuangyang area of Changchun City, 15 cases of serum and cerebrospinal fluid (CSF) remained as group GBS group (20 cases) hospitalized in the first Hospital of Jilin University were selected as sporadic GBS group. CSF routine, biochemical, liver function and hepatitis B antigen, syphilis antibody negative were normal in 20 patients as normal control group. Serum and cerebrospinal fluid (CSF) GM1 and GT1a antibodies were detected by ELISA method. Sex, age, history, clinical features were analyzed by SPSS software. Electrophysiological manifestations and the levels of GM1 and GT1a antibodies in serum and cerebrospinal fluid were analyzed and compared between group and sporadic group of GBS. Results the morbidity of the two groups was higher than that of female, the age of onset was more than 20 or 40 years old, the main manifestations were weakness of limbs, cranial nerve damage mainly appeared diplopia, facial paralysis and dysphagia; There were significant differences between the two groups in the history of previous infection in the digestive tract and respiratory tract, and in the group of mass onset, the infection of the digestive tract was mainly P0. 008). The serum and cerebrospinal fluid (GM1) and GT1a antibody levels in the sporadic group and the sporadic group were significantly higher than those in the normal control group. There was significant difference (P < 0.01), but there was no significant difference in antibody level between the two groups (P > 0.05). The serum and cerebrospinal fluid GT1a antibody levels in GBS patients with bulbar paralysis were higher than those in patients without bulbar palsy. The serum and cerebrospinal fluid GM1 antibody levels in patients with demyelinating and axonal damage were the highest, followed by simple axonal injury, and the lowest in patients with simple demyelination injury. However, there was no significant difference between the three groups in the serum and CSF GM1 and GT1a antibody levels in patients with 4 ~ 6 0.05).(6)Hughes scores, but there was no significant difference between the two groups (P > 0.05). Conclusion the levels of GM1 and GT1a antibody in group and sporadic group were higher than those in normal group, but there was no significant difference between the two groups. It is suggested that the increase of antibody level of GM1 in the same pathophysiological process in the two groups may be related to the changes of electrophysiology of GBS, and the more serious the changes of electrophysiology, the higher the antibody titer. It is hoped that further verification of the sample size will be made in the future.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R745.43

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