| 蔡嘉琳，李志军，唐娜，聂青，付佩彩.创伤/手术后吉兰-巴雷综合征临床特点及短期预后分析[J].神经损伤功能重建,2023,(6):316-319 |
| 创伤/手术后吉兰-巴雷综合征临床特点及短期预后分析 |
| Clinical Characteristics and Short-term Prognosis of Guillain-Barré Syndrome following Trau⁃ma or Surgery |
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| DOI： |
| 中文关键词: 吉兰-巴雷综合征 创伤/手术后 血清炎症标志物 中性粒细胞计数/淋巴细胞计数比值 短期预后 |
| 英文关键词: Guillain-Barré syndrome post-trauma or surgery serum inflammatory markers serum neutrophil count/lymphocyte
count ratio short-term prognosis |
| 基金项目:湖北省自然科学基
金项目（No. 2022C
FB726）；
湖北省卫生健康委
员会科研项目（No.
WJ2021M119） |
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| 中文摘要: |
| 目的：分析创伤/手术后吉兰-巴雷综合征（GBS）患者的临床特点以及短期预后的影响因素。方法：
搜集2016年1月至2022年6月在同济医院神经内科就诊的创伤/手术后GBS患者25例的临床资料和血清
炎性标志物，分析短期预后影响的因素。结果：25例创伤/手术后GBS患者中，男21例，女4例；平均年龄
（49.6±12.6）岁；发病季节以夏秋季节为主。从创伤/手术到GBS症状的平均间隔为（11.4±7.2）d，GBS症状
达峰时间为（9.6±5.4）d。入院时，Hughes评分为（3.36±1.31）分，MRC总分评分为（30.56±16.78）分。28%的
患者进入ICU治疗，24%患者呼吸肌无力/需要呼吸支持。17例（68%）患者接受了静脉免疫球蛋白治疗，3
例（12%）患者接受血浆置换。3例（12%）患者在住院期间死亡。平均住院时间为（22.7±11.6）d。根据出院
时的Hughes评分将患者分为短期预后较差组（Hughes评分≥3分）14例和短期预后较好组（Hughes评分＜
3分）11例，比较2组的临床数据可得：短期预后较差组患者年龄更大（P=0.002）、入院时Hughes评分以及
MRC总分评分更低（P＜0.001）、进入ICU比例更高（P=0.021）、需要呼吸支持的患者比例更多（P=0.043），
出院时Hughes评分及MRC总分评分显著低于预后较好组（均P＜0.001）；血清标志物血清中中性粒细胞计
数/淋巴细胞计数（NLR）、C反应蛋白/白蛋白（CRP/Alb）水平明显高于预后较好组（P=0.005、0.048），血尿酸
水平明显低于较预后较好组（P=0.003）；IgG型抗GM1-抗体阳性患者比例高于预后较好组（P=0.010）。多
因素回归分析显示，入院时MRC总分评分、NLR为创伤/手术后GBS患者短期内预后不良的危险因素。结
论：创伤/手术后GBS患者以重症GBS为主，短期预后差。入院时MRC总分评分、NLR为短期内预后不良
的危险因素。 |
| 英文摘要: |
| To investigate the clinical characteristics of patients with Guillain-Barré syndrome
(GBS) following trauma or surgery and explore factors influencing short-term prognosis. Methods: Clinical data and serum levels of inflammatory markers were collected from 25 patients with trauma- or surgery-related
GBS who were treated at the Department of Neurology of Tongji Hospital from January 2016 to June 2022. The
factors influencing short-term prognosis were analyzed. Results: Among the 25 patients with trauma- or surgery-related GBS, 21 were males and 4 were females, and the mean age was 49.6±12.6 years. In terms of seasons, the onset of symptoms mainly occurred in summer and autumn. The average interval from trauma or surgery to onset of GBS symptoms was 11.4±7.2 days, and the interval from onset to peak GBS symptoms was 9.6±
5.4 days. On admission, the mean Hughes score was 3.36±1.31, and the total Medical Research Council (MRC)
Scale score was 30.56±16.78; 28% of the patients were admitted to the intensive care unit (ICU) for further treatment, and 24% of the patients had respiratory myasthenia or needed ventilation support for dyspneic respiration.
Overall, 17 patients (68%) received intravenous immunoglobulin therapy and three (12%) received plasmapheresis. Three patients (12% ) died during hospitalization. The average length of hospital stay was 22.7±11.6 days.
Based on the Hughes score at discharge, patients were assigned to the poor short-term prognosis group (Hughes
score≥3) (n=14 patients) or the better short-term prognosis group (Hughes score<3) (n=11 patients). Compared
with that noted in the better short-term prognosis group, the clinical characteristics in the poor short-term prognosis group were as follows: older patients (P=0.002), lower Hughes score and total MRC score at admission
(P<0.001), and higher proportion of patients admitted to the ICU (P=0.021) and requiring ventilation support (P=
0.043). Regarding serum inflammatory markers, the serum neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein/albumin ratio (CRP/Alb) were significantly higher in the poor short-term prognosis group than in
the better short-term prognosis group (P=0.005/0.048), whereas the serum uric acid levels were significantly
lower in the poor short-term prognosis group (P=0.003). Moreover, the proportion of patients with positive IgG
anti-GM1-antibodies was higher in the poor short-term prognosis group than in the better short-term prognosis group (P=0.010). Multivariate regression analysis revealed that the total MRC score at admission and NLR were risk factors for poor short-term prognosis in patients
with trauma-related or surgery-related GBS. Conclusion: Patients with trauma- or surgery-related GBS predominantly presented with severe GBS with a poor short-term prognosis. The total MRC score at admission and NLR were risk factors for a poor short-term prognosis. |
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