本文選題：吉蘭-巴雷綜合征 + 老年��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：第一部分老年吉蘭-巴雷綜合征臨床特征與短期預(yù)后的回顧性分析目的:研究老年吉蘭-巴雷綜合征(Guillain-Barrésyndrome,GBS)患者的臨床特征與短期預(yù)后。方法:回顧性分析2003年1月至2014年12月期間就診于吉林大學(xué)第一醫(yī)院的成年GBS患者的臨床資料。根據(jù)年齡將入組患者分為老年組(≥60歲)與非老年組(18-59歲),比較2組患者的臨床特征與短期預(yù)后。結(jié)果:共有535例患者入組,其中老年組67例,中位年齡為69歲;非老年組468例,中位年齡為39歲。與非老年組患者相比,老年組患者前驅(qū)感染率較低(49.3%vs 66.2%,P0.001),就診時(shí)間(5d vs 4d,P=0,010)與疾病達(dá)峰時(shí)間(7d vs 6d,P=0,047)較長(zhǎng)。老年組GBS患者淋巴細(xì)胞比例降低(55.4%vs 37.3%,P=0.005)、低鈉血癥(25.0%vs 10.2%,P=0.001)、低白蛋白血癥(9.0%vs 2.6%,P=0.019)、高血糖(34.3%vs 15.2%,P0.001)的發(fā)生率均高于非老年組患者,但老年組患者住院時(shí)間較長(zhǎng)(17d vs 14d,P=0.010),肺炎發(fā)生率高(29.9%vs18.8%,P=0.035),而且短期預(yù)后不良的比例較高(58.2%vs 42.7%,P=0.017)。對(duì)于重型GBS患者,2組患者在疾病嚴(yán)重程度、治療方案、肺炎發(fā)生率、住院時(shí)間無(wú)明顯差異,但老年患者短期預(yù)后不良的比例較高(84.1%vs 63.8%,P=0.008)。而且高齡(≥60歲)(OR=2.906,95%CI:1.174-7.194,P=0.021)、高峰MRC評(píng)分低(OR=0.948,95%CI:0.927-0.969,P0.001)是重型GBS短期預(yù)后不良的獨(dú)立預(yù)測(cè)因素。結(jié)論:老年GBS患者的臨床特征和短期預(yù)后與非老年患者不同。高齡(≥60歲)與高峰MRC評(píng)分低是重型GBS短期預(yù)后不良的獨(dú)立預(yù)測(cè)因素。第二部82例吉蘭-巴雷綜合征預(yù)后及后遺癥的隨訪研究目的:對(duì)吉蘭-巴雷綜合征(Guillain-Barrésyndrome,GBS)發(fā)病1-6月的預(yù)后及后遺癥情況進(jìn)行分析并探討其相關(guān)影響因素。方法:研究入組了2015年4月至2016年6月就診于吉林大第一醫(yī)院神經(jīng)內(nèi)科的且有有完整隨訪資料的82例GBS住院患者,電話隨訪其預(yù)后及后遺癥情況,并探討臨床特征、實(shí)驗(yàn)室檢驗(yàn)指標(biāo)、治療方法、神經(jīng)電生理分型對(duì)其預(yù)后及后遺癥的影響。結(jié)果:82例患者共有6例患者死亡,其在發(fā)病3月及6月預(yù)后不良的比例分別為32.9%、20.7%。年齡增加(P=0.006)、疾病達(dá)峰時(shí)間短(P0.001)、高峰MRC評(píng)分低(P=0.014)、自主神經(jīng)所累(P0.001)、合并肺炎(P=0.001)、血清Ig G(Immunoglobulin G)水平高(P=0.003)、腦脊液Ig G水平高(P=0.021)、血清超敏C反應(yīng)蛋白(CRP)增高(P=0.007)與患者發(fā)病6月預(yù)后不良相關(guān)。其中共36例輕型患者(43.9%),其在發(fā)病3月后無(wú)預(yù)后不良者,免疫球蛋白治療組與未用免疫球蛋白治療組在發(fā)病1月、2月、3月、6月的HFGS評(píng)分改善均無(wú)明顯差異(P0.05)。急性炎癥性脫髓鞘性多發(fā)神經(jīng)病(acute inflammatory demyelinating polyneuropathies,AIDP)與急性運(yùn)動(dòng)軸索型神經(jīng)病(acute motor axonal neuropathy,AMAN)患者在發(fā)病3個(gè)月預(yù)后不良的比例存在差異(19.5%vs75.0%,P0.001);而6個(gè)月后預(yù)后不良的比例無(wú)明細(xì)差異(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%)患者遺留后遺癥,主要表現(xiàn)為乏力28例(59.6%)、感覺(jué)異常17例(36.2%)、肌肉力量差12例(25.6%)。結(jié)論:大約1/5的GBS患者發(fā)病6月后預(yù)后不良,相關(guān)影響因素包括高齡、疾病達(dá)峰時(shí)間短、高峰MRC評(píng)分低、自主神經(jīng)所累、合并肺炎、血清與腦脊液Ig G水平高、血清CRP增高;輕型患者預(yù)后好,免疫球蛋白治療對(duì)其預(yù)后無(wú)明顯改善;AMAN患者早期預(yù)后差;大部分GBS患者遺留不同形式的后遺癥。
[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.
【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】：2017
【分類號(hào)】：R745.43

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