吉兰-巴雷综合征的临床特征与预后研究

发布时间：2018-06-07 17:09

本文选题：吉兰-巴雷综合征 + 老年　；参考：《吉林大学》2017年硕士论文

【摘要】：第一部分老年吉兰-巴雷综合征临床特征与短期预后的回顾性分析目的:研究老年吉兰-巴雷综合征(Guillain-Barrésyndrome,GBS)患者的临床特征与短期预后。方法:回顾性分析2003年1月至2014年12月期间就诊于吉林大学第一医院的成年GBS患者的临床资料。根据年龄将入组患者分为老年组(≥60岁)与非老年组(18-59岁),比较2组患者的临床特征与短期预后。结果:共有535例患者入组,其中老年组67例,中位年龄为69岁;非老年组468例,中位年龄为39岁。与非老年组患者相比,老年组患者前驱感染率较低(49.3%vs 66.2%,P0.001),就诊时间(5d vs 4d,P=0,010)与疾病达峰时间(7d vs 6d,P=0,047)较长。老年组GBS患者淋巴细胞比例降低(55.4%vs 37.3%,P=0.005)、低钠血症(25.0%vs 10.2%,P=0.001)、低白蛋白血症(9.0%vs 2.6%,P=0.019)、高血糖(34.3%vs 15.2%,P0.001)的发生率均高于非老年组患者,但老年组患者住院时间较长(17d vs 14d,P=0.010),肺炎发生率高(29.9%vs18.8%,P=0.035),而且短期预后不良的比例较高(58.2%vs 42.7%,P=0.017)。对于重型GBS患者,2组患者在疾病严重程度、治疗方案、肺炎发生率、住院时间无明显差异,但老年患者短期预后不良的比例较高(84.1%vs 63.8%,P=0.008)。而且高龄(≥60岁)(OR=2.906,95%CI:1.174-7.194,P=0.021)、高峰MRC评分低(OR=0.948,95%CI:0.927-0.969,P0.001)是重型GBS短期预后不良的独立预测因素。结论:老年GBS患者的临床特征和短期预后与非老年患者不同。高龄(≥60岁)与高峰MRC评分低是重型GBS短期预后不良的独立预测因素。第二部82例吉兰-巴雷综合征预后及后遗症的随访研究目的:对吉兰-巴雷综合征(Guillain-Barrésyndrome,GBS)发病1-6月的预后及后遗症情况进行分析并探讨其相关影响因素。方法:研究入组了2015年4月至2016年6月就诊于吉林大第一医院神经内科的且有有完整随访资料的82例GBS住院患者,电话随访其预后及后遗症情况,并探讨临床特征、实验室检验指标、治疗方法、神经电生理分型对其预后及后遗症的影响。结果:82例患者共有6例患者死亡,其在发病3月及6月预后不良的比例分别为32.9%、20.7%。年龄增加(P=0.006)、疾病达峰时间短(P0.001)、高峰MRC评分低(P=0.014)、自主神经所累(P0.001)、合并肺炎(P=0.001)、血清Ig G(Immunoglobulin G)水平高(P=0.003)、脑脊液Ig G水平高(P=0.021)、血清超敏C反应蛋白(CRP)增高(P=0.007)与患者发病6月预后不良相关。其中共36例轻型患者(43.9%),其在发病3月后无预后不良者,免疫球蛋白治疗组与未用免疫球蛋白治疗组在发病1月、2月、3月、6月的HFGS评分改善均无明显差异(P0.05)。急性炎症性脱髓鞘性多发神经病(acute inflammatory demyelinating polyneuropathies,AIDP)与急性运动轴索型神经病(acute motor axonal neuropathy,AMAN)患者在发病3个月预后不良的比例存在差异(19.5%vs75.0%,P0.001);而6个月后预后不良的比例无明细差异(17.1%vs 31.3%,P=0.413)。76例患者(排除6例死亡患者)中,共有47例(61.8%)患者遗留后遗症,主要表现为乏力28例(59.6%)、感觉异常17例(36.2%)、肌肉力量差12例(25.6%)。结论:大约1/5的GBS患者发病6月后预后不良,相关影响因素包括高龄、疾病达峰时间短、高峰MRC评分低、自主神经所累、合并肺炎、血清与脑脊液Ig G水平高、血清CRP增高;轻型患者预后好,免疫球蛋白治疗对其预后无明显改善;AMAN患者早期预后差;大部分GBS患者遗留不同形式的后遗症。
[Abstract]:Part 1 a retrospective analysis of the clinical characteristics and short-term prognosis of GERAN Barre syndrome Objective: To study the clinical characteristics and short-term prognosis of Guillain-Barr E syndrome (GBS) patients. Methods: a retrospective analysis of the adult GBS patients in No.1 Hospital of Jilin University from January 2003 to December 2014. Clinical data. According to the age group, the patients were divided into the elderly group (> 60 years old) and the non elderly group (18-59 years old). The clinical characteristics and short-term prognosis of the 2 groups were compared. Results: there were 535 patients in the group, including 67 cases in the elderly group, the median age of 69, 468 in the non elderly group and 39 in the middle age group. The rate of prodrome infection was low (49.3%vs 66.2%, P0.001), the time of 5D vs 4D (P=0010) and the peak time of the disease (7d vs 6D, P=0047) were longer. The rate of birth was higher than that in the non aged group, but the hospitalization time of the elderly patients was longer (17D vs 14d, P=0.010), the incidence of pneumonia was high (29.9%vs18.8%, P=0.035), and the proportion of short-term prognosis was higher (58.2%vs 42.7%, P=0.017). For the severe GBS patients, the severity of disease, the treatment plan, the incidence of pneumonia, and the time of hospitalization were not obvious. But the proportion of the elderly patients with poor short-term prognosis was higher (84.1%vs 63.8%, P=0.008). And the elderly (> 60 years old) (OR=2.906,95%CI:1.174-7.194, P=0.021), the low peak MRC score (OR=0.948,95%CI:0.927-0.969, P0.001) were the independent prognostic factors of severe GBS short-term prognosis. Conclusion: the clinical characteristics and short-term prognosis of elderly patients with GBS and short-term prognosis and prognosis. The elderly (60 years old) and the low peak MRC score were independent predictors of the short-term prognosis of severe GBS. The prognosis and sequelae of second 82 cases of Gillain Barre syndrome were followed up: the prognosis and sequelae of the 1-6 months of the disease of Gillain Barre syndrome (Guillain-Barr E syndrome, GBS) were analyzed and explored. Methods: 82 patients who were hospitalized in the neurology department of the first hospital of Jilin from April 2015 to June 2016 were enrolled in 82 patients with complete follow-up data. The prognosis and sequelae were followed up by telephone, and the clinical features, laboratory test indexes, treatment methods, and neurophysiologic typing were used to evaluate the prognosis of the patients. Results: the impact of sequelae. Results: there were 6 cases of death in 82 patients. The proportion of poor prognosis in March and June was 32.9%, 20.7%. age increased (P=0.006), peak time of disease was short (P0.001), peak MRC score was low (P=0.014), autonomic nerve (P0.001), pneumonia (P=0.001), and Ig G (Immunoglobulin G) in serum (P=0.) was high (P=0.) (P=0.) was high (P=0.) (P=0.) was high (P=0.) (P=0.) was high (P=0.) (P=0.) was high (P=0.) (P=0.) was high (P=0.) (P=0.) was high (P=0.) (P=0.), and the level of Immunoglobulin G (P=0.) was high (P=0.). 003) the high level of Ig G in cerebrospinal fluid (P=0.021), the increase of serum hypersensitivity C reactive protein (CRP) (P=0.007) was associated with the poor prognosis of the patients in June. There were 36 cases of light patients (43.9%), and there was no poor prognosis after the onset of the disease. The immunoglobulin treatment group and the unused immunoglobulin therapy group improved the HFGS scores in January, February, March and June. There was no significant difference (P0.05). The proportion of acute inflammatory demyelinating polyneuropathy (acute inflammatory demyelinating polyneuropathies, AIDP) and acute motor axonal neuropathy (acute motor axonal neuropathy, AMAN) had a difference in the 3 month poor prognosis (19.5%vs75.0%,) and the ratio of poor prognosis after 6 months. There was no clear and detailed difference (17.1%vs 31.3%, P=0.413) in.76 patients (6 cases of death), of which 47 cases (61.8%) were left sequelae, mainly manifested in 28 cases (59.6%), 17 cases (36.2%) and 12 (25.6%) muscle strength difference (25.6%). Conclusion: the prognosis of GBS patients with large about 1/5 was poor after June, related factors included age, disease. The peak time is short, the peak MRC score is low, the autonomic nerve is tired, the pneumonia is combined, the serum and cerebrospinal fluid Ig G level is high, the serum CRP is higher, the prognosis of the light patients is good, the immunoglobulin treatment has no obvious improvement on the prognosis; the early prognosis of the AMAN patients is poor; most of the GBS patients have different forms of sequelae.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R745.43

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