本文選題：吉蘭-巴雷綜合征 + 神經(jīng)免疫��； 參考：《第二軍醫(yī)大學》2017年碩士論文

【摘要】：研究目的:分析吉蘭-巴雷綜合征(Guillain-Barre Snydrome,GBS)住院患者臨床、電生理,生化特點以及臨床轉歸的相關因素,隨訪并探討影響GBS恢復期延長的相關因素。研究方法:回顧性分析2006年6月-2016年6月我院收治的144例GBS患者臨床、電生理、生化資料,根據(jù)出入院Hughes評分差值分為轉歸良好組(ΔHughes0)和轉歸不良組(ΔHughes≥0),比較兩組間臨床、電生理、生化指標對轉歸的影響;通過Logistic回歸分析探究轉歸不良的相關預測因素。隨訪2014年6月至2016年6月的98例吉蘭巴雷綜合征患者出院后第3、6月恢復情況,依據(jù)恢復期時間分為恢復較快組(恢復期≤6個月)與恢復延長組(恢復期6個月),比較兩組臨床、電生理以及生化指標對恢復期時間的影響,通過Logistic回歸分析探究恢復期延長的相關因素。研究結果:回顧性病人總數(shù)144例,男性89例,女性55例,平均發(fā)病年齡(46.24±16.07)歲,出院時轉歸良好組109例,占75.69%,轉歸不良組35例,占24.31%。臨床轉歸分組單因素比較中,兩組間性別、年齡、發(fā)病季節(jié)、前驅事件、合并高血壓病、2型糖尿病、慢性乙型肝炎、顱神經(jīng)受累、自主神經(jīng)受累、肌肉萎縮、肺部感染、機械通氣、腦脊液(cerebrospinal fluid,CSF)蛋白、腦脊液白蛋白/血清白蛋白(albumin cerebrospinal fluid/serum,QALB)、腦脊液免疫球蛋白(IgG)、腦脊液免疫球蛋白(IgG)指數(shù)、腦脊液24小時鞘內(nèi)合成率、肌電圖損傷形式比較無統(tǒng)計學差異(均P0.05);合并自身免疫疾病、入院前病程2周、血IgG無升高與臨床轉歸不良有關(均P0.05);在多因素分析中,年齡≥55歲(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)、病程中行機械通氣(P=0.02,OR=24.74,OR的95%CI:1.81-339.19)與臨床轉歸不良有關;而病程≤2周(P0.01,OR=0.06,OR的95%CI:0.01-0.23),血IgG明顯升高(P=0.03,OR=0.09,OR的95%CI:0.009-0.79)則是保護性因素,與臨床轉歸良好有關。隨訪98例初診為GBS患者,6例患者死亡,2例患者復發(fā),12例失訪,最終對78例患者進行了隨訪,依據(jù)患者恢復期時間分為恢復較快與恢復延長組,恢復期時間單因素分析中,兩組之間患者年齡、性別、發(fā)病季節(jié)、合并自身免疫性疾病、2型糖尿病、顱神經(jīng)受累、自主神經(jīng)受累、機械通氣、入院前病程、血IgG、腦脊液IgG、腦脊液IgG指數(shù)比較無統(tǒng)計學差異(均P0.05);而腦脊液蛋白升高,腦脊液白蛋白/血清白蛋白(QALB)升高、神經(jīng)軸索型損傷可能與GBS恢復期延長有關(均P0.05);在多因素分析中,腦脊液白蛋白/血清白蛋白(QALB)(P=0.02,OR=4.39,OR的95%CI:1.21-15.90)、神經(jīng)軸索型損傷(P=0.03,OR=3.52,OR的95%CI:1.16-10.71),是GBS恢復期延長的獨立危險因素。研究結論:通過回顧性分析我們得出以下結論:入院前病程≤2周、血IgG水平升高顯著是GBS轉歸良好的保護性因素。而年齡≥55歲、合并自身免疫疾病、機械通氣則可能是GBS轉歸不良的獨立危險因素,對于這類GBS患者,則應盡早實行個體化治療,加強監(jiān)護、嚴密觀察病情,必要時轉入ICU病房。此外通過隨訪分析我們得出以下結論:腦脊液QALB升高,神經(jīng)軸索損傷是GBS恢復期延長的獨立危險因素,上述指標有望成為恢復期延長的預測因子,對這類患者應盡早行免疫治療和康復訓練,促進損傷神經(jīng)修復。
[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.
【學位授予單位】：第二軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R745.43

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