吉兰巴雷综合征预后的相关因素分析

发布时间：2018-06-21 02:52

本文选题：吉兰-巴雷综合征 + 神经免疫　；参考：《第二军医大学》2017年硕士论文

【摘要】：研究目的:分析吉兰-巴雷综合征(Guillain-Barre Snydrome,GBS)住院患者临床、电生理,生化特点以及临床转归的相关因素,随访并探讨影响GBS恢复期延长的相关因素。研究方法:回顾性分析2006年6月-2016年6月我院收治的144例GBS患者临床、电生理、生化资料,根据出入院Hughes评分差值分为转归良好组(ΔHughes0)和转归不良组(ΔHughes≥0),比较两组间临床、电生理、生化指标对转归的影响;通过Logistic回归分析探究转归不良的相关预测因素。随访2014年6月至2016年6月的98例吉兰巴雷综合征患者出院后第3、6月恢复情况,依据恢复期时间分为恢复较快组(恢复期≤6个月)与恢复延长组(恢复期6个月),比较两组临床、电生理以及生化指标对恢复期时间的影响,通过Logistic回归分析探究恢复期延长的相关因素。研究结果:回顾性病人总数144例,男性89例,女性55例,平均发病年龄(46.24±16.07)岁,出院时转归良好组109例,占75.69%,转归不良组35例,占24.31%。临床转归分组单因素比较中,两组间性别、年龄、发病季节、前驱事件、合并高血压病、2型糖尿病、慢性乙型肝炎、颅神经受累、自主神经受累、肌肉萎缩、肺部感染、机械通气、脑脊液(cerebrospinal fluid,CSF)蛋白、脑脊液白蛋白/血清白蛋白(albumin cerebrospinal fluid/serum,QALB)、脑脊液免疫球蛋白(IgG)、脑脊液免疫球蛋白(IgG)指数、脑脊液24小时鞘内合成率、肌电图损伤形式比较无统计学差异(均P0.05);合并自身免疫疾病、入院前病程2周、血IgG无升高与临床转归不良有关(均P0.05);在多因素分析中,年龄≥55岁(P=0.03,OR=4.03,OR的95%CI:1.16-14.01),合并自身免疫疾病(P=0.04,OR=8.37,OR的95%CI:1.16-60.28)、病程中行机械通气(P=0.02,OR=24.74,OR的95%CI:1.81-339.19)与临床转归不良有关;而病程≤2周(P0.01,OR=0.06,OR的95%CI:0.01-0.23),血IgG明显升高(P=0.03,OR=0.09,OR的95%CI:0.009-0.79)则是保护性因素,与临床转归良好有关。随访98例初诊为GBS患者,6例患者死亡,2例患者复发,12例失访,最终对78例患者进行了随访,依据患者恢复期时间分为恢复较快与恢复延长组,恢复期时间单因素分析中,两组之间患者年龄、性别、发病季节、合并自身免疫性疾病、2型糖尿病、颅神经受累、自主神经受累、机械通气、入院前病程、血IgG、脑脊液IgG、脑脊液IgG指数比较无统计学差异(均P0.05);而脑脊液蛋白升高,脑脊液白蛋白/血清白蛋白(QALB)升高、神经轴索型损伤可能与GBS恢复期延长有关(均P0.05);在多因素分析中,脑脊液白蛋白/血清白蛋白(QALB)(P=0.02,OR=4.39,OR的95%CI:1.21-15.90)、神经轴索型损伤(P=0.03,OR=3.52,OR的95%CI:1.16-10.71),是GBS恢复期延长的独立危险因素。研究结论:通过回顾性分析我们得出以下结论:入院前病程≤2周、血IgG水平升高显著是GBS转归良好的保护性因素。而年龄≥55岁、合并自身免疫疾病、机械通气则可能是GBS转归不良的独立危险因素,对于这类GBS患者,则应尽早实行个体化治疗,加强监护、严密观察病情,必要时转入ICU病房。此外通过随访分析我们得出以下结论:脑脊液QALB升高,神经轴索损伤是GBS恢复期延长的独立危险因素,上述指标有望成为恢复期延长的预测因子,对这类患者应尽早行免疫治疗和康复训练,促进损伤神经修复。
[Abstract]:Objective: to analyze the clinical, electrophysiological, biochemical characteristics and related factors of clinical outcomes in Guillain-Barre Snydrome (GBS) inpatients, follow up and explore the related factors affecting the prolongation of the GBS recovery period. A retrospective analysis of the clinical and electrophysiology of 144 cases of GBS in our hospital in June -2016 June 2006. The biochemical data were divided into good group (delta Hughes0) and bad outcome group (delta Hughes > 0) according to the difference of the Hughes score of the entrance and exit. The effects of clinical, electrophysiological and biochemical indexes on the outcome were compared between the two groups, and the related predictive factors were investigated by Logistic regression analysis. 98 cases of Gillain Barre synthesis from June 2014 to June 2016 were followed up. The recovery of the patients after discharge was divided into 3,6 months after discharge. According to the recovery time, the recovery period was divided into faster recovery group (recovery period less than 6 months) and the recovery extension group (6 months of recovery period). The effects of electrophysiological and biochemical indexes on the recovery time were compared between the two groups. The related factors of the extension of the recovery period were analyzed by Logistic regression analysis. The results of the study were retrospective. The total number of patients was 144, 89 male and 55 female, with the average age of onset (46.24 + 16.07), 109 cases in good group, 75.69% and 35 in bad group, which accounted for the single factor comparison of 24.31%. clinical outcome group. The sex, age, onset season, pre drive event, hypertension, type 2 diabetes, chronic hepatitis B, cranial nerve between the two groups. Involvement, autonomic nerve involvement, muscle atrophy, pulmonary infection, mechanical ventilation, cerebrospinal fluid (cerebrospinal fluid, CSF) protein, cerebrospinal fluid albumin / serum albumin (albumin cerebrospinal fluid/serum, QALB), cerebrospinal fluid immunoglobulin (IgG), cerebrospinal fluid immunoglobulin (IgG) index, cerebrospinal fluid 24 hour intrathecal synthesis rate, electromyography injury shape There was no statistical difference (all P0.05); with autoimmune diseases and 2 weeks before admission, the blood IgG was not elevated associated with poor clinical outcome (P0.05); in multivariate analysis, age (P=0.03, OR=4.03, OR 95%CI:1.16-14.01), combined with autoimmune disease (P=0.04, OR=8.37, OR 95%CI:1.16-60.28), and mechanical ventilation in the course of the disease. P=0.02, OR=24.74, and 95%CI:1.81-339.19 of OR were associated with poor clinical outcome, while the course of the disease was less than 2 weeks (P0.01, OR=0.06, OR 95%CI:0.01-0.23), and the blood IgG increased significantly (P=0.03, OR=0.09, OR) was a protective factor and was associated with a good clinical outcome. 98 cases were followed up, 6 patients died, 2 cases had relapsed, 12 cases lost. 78 patients were followed up. According to the patient's recovery time, the patients were divided into a quick recovery and an extension group and a single factor analysis of the recovery time. The age of the two groups, the sex, the onset season, the combination of autoimmune diseases, type 2 diabetes, cranial nerve involvement, autonomic nervous involvement, mechanical ventilation, the course of admission before admission, blood IgG, brain Spinal fluid IgG, IgG index of cerebrospinal fluid was not statistically significant (P0.05), while cerebrospinal fluid protein increased, CSF albumin / serum albumin (QALB) increased, and nerve axon type injury may be associated with the prolongation of GBS recovery period (P0.05); in multivariate analysis, cerebrospinal fluid albumin / serum albumin (QALB) (P=0.02, OR=4.39, OR 95%CI:1.21-15.90) (P=0.03, OR=3.52, OR 95%CI:1.16-10.71) is an independent risk factor for prolonged GBS recovery. Conclusion: through retrospective analysis, we concluded that the level of blood IgG is less than 2 weeks before admission, and the elevated blood IgG level is a significant protective factor for GBS, and the age is more than 55 years old, with autoimmune disease, machinery. Ventilation may be an independent risk factor for poor GBS prognosis. For this type of GBS patients, individualized treatment should be carried out as early as possible, intensive care, strict observation of the condition, and transferred to the ICU ward when necessary. In addition, the following conclusions are made: the elevation of QALB in cerebrospinal fluid and the damage of the axonal cord injury are independent risk factors for the prolongation of the recovery period of GBS. These indicators are expected to become predictive factors for the recovery period. For these patients, immunotherapy and rehabilitation training should be done as early as possible to promote nerve repair.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R745.43

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