格林一巴利综合征患者临床特征和脑脊液免疫指标的回顾性分析

发布时间：2018-06-27 09:52

  本文选题：格林一巴利综合征 + 临床特征　； 参考：《郑州大学》2014年硕士论文

【摘要】：研究目的与背景 格林一巴利综合征（Guillain-Barré syndrome，GBS），又称为急性感染性多发性神经根神经炎，是由感染等因素诱导的，细胞免疫和体液免疫共同介导的，以周围神经损伤为主要特征的神经系统自身免疫性疾病。其临床特点是急性起病，多有前驱感染史，进行性加重的四肢对称性运动障碍，感觉和自主神经可受累，脑脊液出现特征性的蛋白一细胞分离现象。GBS是目前急性迟缓性瘫痪的最常见病因。GBS多为单向病程，期间可有短暂波动，多数患者预后较好，最终可以达到完全恢复，仍有部分患者会遗留较为严重的后遗症，少数重症患者预后不良，，主要死于呼吸衰竭、严重心律失常等并发症。 GBS的病因及发病机制尚未完全明了，目前认为GBS患者体内既存在细胞介导的免疫反应，又存在体液免疫因素。目前临床上对于GBS的诊断，除了依靠临床表现和神经电生理学资料外，实验室检查也起着重要作用。GBS早期神经电生理学及常规检查的病理学改变并不明显，而脑脊液中免疫球蛋白lgG的增加发生的较早。因为血脑屏障的存在，免疫系统的成分不能进入中枢神经系统，中枢神经系统被认为是“免疫特免区”。但是中枢神经系统发生免疫反应时，血脑屏障可能受到损害，因而不能准确评价CSF中的免疫球蛋白是来自血液渗透还是自身鞘内合成。研究资料表明，Alb商值能评估血脑屏障完整性，而IgG指数和24小时IgG合成率能准确反映中枢神经系统的免疫功能状态。因此，进行脑脊液IgG、Alb商值、IgG指数和24小时IgG合成率的测定对GBS的早期诊断有重要意义。 相关的临床研究发现，脑脊液免疫指标水平可能与GBS病情严重程度相关。在疾病的早期分析其主要特点以及预测病情的严重程度，利于对患者采取积极治疗，对降低其致残率、病死率有积极的指导意义。现将我院2012年6月至2014年2月期间住院治疗的有完整病历资料的60例GBS患者信息进行临床分析，并将其分为轻型和重型两组，总结临床特征和脑脊液免疫指标等特点；对比分析其异同；旨在筛选出预测GBS患者病情严重程度的相关因素，以指导临床医生对其进行早期干预和治疗。 资料与方法 收集2012年6月至2014年2月期间在郑州大学第一附属医院进行住院治疗的有完整病历资料的60例GBS患者信息。将GBS患者按Hughes评分标准分为轻重两组：轻型GBS组Hughes评分在1～3分之间，重型GBS组Hughes评分在4～6分之间。 应用统计学软件SSPS17.0分析比较两组患者临床特点和脑脊液免疫指标的水平有无显著性差异。定量资料用均数±标准差表示，两组定量资料采用两独立样本的t检验进行比较，定性资料采用卡方检验进行比较。P＜0.05为显著性差异，表示有统计学意义。 结果 1.60例GBS患者，其中轻型35例，重型25例，重型GBS组的患者在性别、年龄、前驱事件、肌电图分型的构成上与轻型GBS组相比无显著性差异（P＞0.05）。 2.重型GBS组腱反射消失患者所占比例明显高于轻型GBS组，有显著性差异（P＜0.05）。 3.重型GBS组治疗有效患者所占比例明显低于轻型GBS组，呼吸肌麻痹组患者治疗有效患者所占比例明显低于无呼吸肌麻痹组患者，两者均有显著性差异（P＜0.05）。 4.重型GBS组患者脑脊液蛋白平均值、Alb商值平均值与轻型GBS组相比无显著性差异（P＞0.05）。 5.重型GBS组患者脑脊液IgG、IgG指数平均值、24小时IgG合成率平均值明显高于轻型GBS组，有显著性差异（P＜0.05）。 结论 1.GBS患者的性别，年龄，发病前有无前驱事件，肌电图不同分型均与其病情严重程度无显著相关性。 2.重型GBS组患者、呼吸肌麻痹组患者治疗有效率低于轻型GBS组及无呼吸肌麻痹组。 3.GBS患者腱反射减弱程度、脑脊液中IgG增加程度、IgG指数增高程度、24小时IgG合成率增加程度和患者病情严重程度呈正相关。
[Abstract]:Research purpose and background
Green's Guillain-Barr syndrome (GBS), also known as acute infectious multiple nerve root neuritis, is an epidemic disease of the nervous system, which is induced by infection and other factors, including cell immunity and humoral immunity, which is characterized by peripheral nerve damage. Its clinical characteristics are acute onset and many precursors. The history of infection, progressive symmetric dyskinesia, sensory and autonomic nerves can be involved, and the characteristic protein one cell separation of cerebrospinal fluid (.GBS) is the most common cause of acute retarded paralysis..GBS is a one-way course of disease, and there is a short fluctuation during the period. The prognosis of the multiple patients is better, and the final recovery can be achieved. There are still some patients who are left with more serious sequelae. A few severe patients have poor prognosis, mainly from respiratory failure, severe arrhythmia and other complications.
The etiology and pathogenesis of GBS have not been fully understood. At present, it is believed that there are both cellular mediated immune responses and humoral immune factors in GBS patients. At present, in clinical diagnosis of GBS, laboratory examination also plays an important role in the early neurophysiology and routine of.GBS, in addition to clinical and neuroelectrophysiological data. The pathological changes are not obvious, and the increase of immunoglobulin lgG in the cerebrospinal fluid is earlier. Because of the presence of the blood brain barrier, the components of the immune system cannot enter the central nervous system and the central nervous system is considered as a "immune special zone". However, the blood brain barrier may be affected by the central nervous system when the immune response occurs. To the damage, it is impossible to accurately assess whether the immunoglobulin in CSF is derived from blood infiltration or intrathecal synthesis. Research data show that the Alb quotient value can assess the integrity of the blood brain barrier, and the IgG index and the 24 hour IgG synthesis rate can accurately reflect the immune functional states of the central nervous system. Therefore, the IgG, Alb quotient, and IgG index of cerebrospinal fluid are carried out. The determination of IgG synthesis rate at 24 hours is very important for early diagnosis of GBS.
Related clinical studies have found that the level of cerebrospinal fluid immunity may be associated with the severity of GBS's condition. Early analysis of its main characteristics and prediction of the severity of the disease is conducive to the active treatment of the patients, the reduction of their disability rate, and the positive guiding significance of the mortality rate. The hospital is now from June 2012 to February 2014. 60 cases of GBS patients with complete medical records for hospitalization were analyzed and divided into two groups of light and heavy-duty, and summarized the characteristics of clinical features and cerebrospinal fluid immunity, compared and analyzed their similarities and differences. The purpose was to screen out the related factors for predicting the severity of GBS patients, so as to guide the clinicians to do their early dry. Pre and treatment.
Information and methods
60 cases of GBS patients with complete medical records in the First Affiliated Hospital of Zhengzhou University from June 2012 to February 2014 were collected. The GBS patients were divided into two groups according to the Hughes score standard: the Hughes score of the light GBS group was 1~3, and the Hughes score of the heavy GBS group was between 4~6 points.
There was no significant difference between the clinical characteristics of the two groups and the level of the cerebrospinal fluid immunity in the two groups. The quantitative data were expressed with the mean mean deviation of the average number. The two groups of quantitative data were compared with the t test of two independent samples. The qualitative data were compared with the chi square test to compare the significant difference between the two and the 0.05. There is a statistical significance.
Result
1.60 cases of GBS patients, of which 35 cases of light, 25 cases, and severe GBS group were not significantly different from the light GBS group (P > 0.05) in the composition of sex, age, prodrome and EMG.
2. the proportion of patients with disappearance of tendon reflex in severe GBS group was significantly higher than that in light GBS group, with significant difference (P < 0.05).
3. the proportion of effective patients in the severe GBS group was significantly lower than that in the light GBS group. The proportion of effective patients in the respiratory muscle paralysis group was significantly lower than that in the non respiratory muscle paralysis group (P < 0.05).
4. the mean value of CSF protein and Alb quotient of severe GBS group were not significantly different from those of light GBS group (P > 0.05).
5. the average value of CSF IgG and IgG index and the 24 hour IgG synthesis rate in the severe GBS group were significantly higher than those in the mild GBS group, with significant difference (P < 0.05).
conclusion
There was no precursor event in patients with 1.GBS. There was no significant correlation between the different types of EMG and the severity of the disease.
2. in severe GBS group, the effective rate of respiratory muscle paralysis group was lower than that of light GBS group and no respiratory muscle paralysis group.
The degree of attenuation of tendon reflex in 3.GBS patients, the increase of IgG in cerebrospinal fluid and the increase of IgG index, the increase of IgG synthesis rate in 24 hours was positively correlated with the severity of the patient's condition.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R745.43

【参考文献】

中国期刊全文数据库 前9条

1 刘洪波;方树友;张炳谦;连亚军;;神经生长因子治疗格林-巴利综合征116例疗效观察[J];山东医药;2007年10期

2 刘业松;刘颖;邓红亮;王小洁;胡景伟;吴小英;申健;;格林—巴利综合征血、脑脊液IgG指数及寡克隆区带测定的意义[J];山东医药;2007年22期

3 沈霞;;中枢神经系统疾病的免疫学检验[J];检验医学;2006年04期

4 袁尚华;;恶性淋巴瘤合并格林-巴利综合征1例[J];现代中西医结合杂志;2008年06期

5 马亚玲;朱永庆;张团炜;;格林-巴利综合征电生理改变与预后的关系[J];延安大学学报(医学科学版);2005年03期

6 杨清成;吉兰-巴雷综合征自主神经损害与病死率的关系探讨[J];中国综合临床;2001年11期

7 江文,王洪典,徐燕,吴保仁,王津存,任雪芳;陕西地区格林巴利综合征电生理学分型[J];中华物理医学与康复杂志;2000年06期

8 刘洪波;方树友;王玉萍;连亚军;张桔;陈丽君;刘桂芳;李建慧;;格林-巴利综合征患者脑脊液IL-10、IL-12水平的研究[J];中国免疫学杂志;2007年08期

9 武晓玲;郝建萍;王淑珍;于红霞;;外伤、手术及神经节苷酯相关格林巴利综合征[J];中国医药指南;2013年29期

本文编号：2073525