本文選題：吉蘭-巴雷綜合征 + 臨床特征　； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：背景及目的：吉蘭-巴雷綜合征（Guillain-Barré Syndrome，，GBS）多以散發(fā)為主，2007年6月～7月發(fā)生在長(zhǎng)春市雙陽(yáng)地區(qū)的36例GBS患者屬于區(qū)域性暴發(fā)流行。GBS發(fā)病機(jī)制目前尚不明確，大部分學(xué)者認(rèn)為神經(jīng)節(jié)苷脂（Ganglioside，GS）抗體與GBS的發(fā)生有關(guān)，GBS患者體內(nèi)可檢測(cè)到相應(yīng)抗體水平升高，不同的GS抗體與GBS的臨床分型有關(guān)，但群發(fā)與散發(fā)GBS患者體內(nèi)抗體水平是否存在差異國(guó)內(nèi)外未見(jiàn)報(bào)道。本文主要通過(guò)ELISA方法檢測(cè)群發(fā)與散發(fā)GBS血清和腦脊液GM1、GT1a抗體來(lái)比較兩者抗體水平是否存在差異，并分析抗體水平與臨床表現(xiàn)之間的關(guān)系。 研究方法：長(zhǎng)春市雙陽(yáng)地區(qū)臨床資料、血清及腦脊液標(biāo)本保留的15例患者作為群發(fā)GBS組、2012.4～2012.10在吉林大學(xué)第一醫(yī)院住院的20例患者作為散發(fā)GBS組，同時(shí)選取2012.6～2013.1以頭痛為主要癥狀，經(jīng)腰穿檢查腦脊液常規(guī)、生化、肝功正常且乙肝抗原、梅毒抗體陰性的20例患者作為正常對(duì)照組。應(yīng)用ELISA方法檢測(cè)三組間血清和腦脊液GM1和GT1a抗體的含量，并應(yīng)用SPSS軟件對(duì)性別、年齡、前驅(qū)史、臨床特征、電生理表現(xiàn)以及血清和腦脊液GM1和GT1a抗體的含量等因素在群發(fā)組和散發(fā)組GBS間進(jìn)行分析比較。 研究結(jié)果：（1）兩組發(fā)病率均男性高于女性；發(fā)病年齡以20～40歲多見(jiàn)；主要表現(xiàn)為四肢無(wú)力；顱神經(jīng)損害主要出現(xiàn)復(fù)視、面癱及吞咽困難；電生理表現(xiàn)以軸索損傷為主。（2）兩組的前驅(qū)感染史消化道和呼吸道有統(tǒng)計(jì)學(xué)差異，群發(fā)組以消化道感染（P=0.008)為主，散發(fā)組以呼吸道感染（P=0.026）為主。（3）群發(fā)組和散發(fā)組患者的血清和腦脊液GM1和GT1a抗體水平較正常對(duì)照組顯著升高，具有顯著性差異（P＜0.01），但抗體水平在兩組之間無(wú)明顯差異（P＞0.05）。（4）伴球麻痹的GBS患者血清和腦脊液GT1a抗體水平高于無(wú)球麻痹癥狀患者，具有顯著性差異（P＜0.05）。（5）電生理表現(xiàn)以脫髓鞘合并軸索損害為主的患者血清和腦脊液GM1抗體水平最高，其次為單純軸索損傷，單純脫髓鞘損傷者抗體水平最低，但三組之間無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。（6）Hughes評(píng)分4～6分患者的血清和腦脊液GM1和GT1a抗體水平高于1～3分的患者，但兩者之間無(wú)統(tǒng)計(jì)學(xué)差異（P＞0.05）。 研究結(jié)論：（1）群發(fā)組以消化道感染為主，散發(fā)組以呼吸道感染為主。（2）群發(fā)組和散發(fā)組GM1和GT1a抗體水平均高于正常組，但兩組間沒(méi)有統(tǒng)計(jì)學(xué)差異，提示兩組病理生理過(guò)程相同。（3）GT1a抗體水平升高可能與球麻痹有關(guān)。（4）GM1抗體水平與GBS的電生理改變可能有關(guān)，電生理改變?cè)街乜贵w滴度越高，希望未來(lái)擴(kuò)大樣本量進(jìn)一步驗(yàn)證。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R745.43

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