本文選題：格林一巴利綜合征 + 臨床特征　； 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：研究目的與背景 格林一巴利綜合征（Guillain-Barré syndrome，GBS），又稱為急性感染性多發(fā)性神經(jīng)根神經(jīng)炎，是由感染等因素誘導(dǎo)的，細(xì)胞免疫和體液免疫共同介導(dǎo)的，以周圍神經(jīng)損傷為主要特征的神經(jīng)系統(tǒng)自身免疫性疾病。其臨床特點(diǎn)是急性起病，多有前驅(qū)感染史，進(jìn)行性加重的四肢對稱性運(yùn)動(dòng)障礙，感覺和自主神經(jīng)可受累，腦脊液出現(xiàn)特征性的蛋白一細(xì)胞分離現(xiàn)象。GBS是目前急性遲緩性癱瘓的最常見病因。GBS多為單向病程，期間可有短暫波動(dòng)，多數(shù)患者預(yù)后較好，最終可以達(dá)到完全恢復(fù)，仍有部分患者會(huì)遺留較為嚴(yán)重的后遺癥，少數(shù)重癥患者預(yù)后不良，，主要死于呼吸衰竭、嚴(yán)重心律失常等并發(fā)癥。 GBS的病因及發(fā)病機(jī)制尚未完全明了，目前認(rèn)為GBS患者體內(nèi)既存在細(xì)胞介導(dǎo)的免疫反應(yīng)，又存在體液免疫因素。目前臨床上對于GBS的診斷，除了依靠臨床表現(xiàn)和神經(jīng)電生理學(xué)資料外，實(shí)驗(yàn)室檢查也起著重要作用。GBS早期神經(jīng)電生理學(xué)及常規(guī)檢查的病理學(xué)改變并不明顯，而腦脊液中免疫球蛋白lgG的增加發(fā)生的較早。因?yàn)檠X屏障的存在，免疫系統(tǒng)的成分不能進(jìn)入中樞神經(jīng)系統(tǒng)，中樞神經(jīng)系統(tǒng)被認(rèn)為是“免疫特免區(qū)”。但是中樞神經(jīng)系統(tǒng)發(fā)生免疫反應(yīng)時(shí)，血腦屏障可能受到損害，因而不能準(zhǔn)確評價(jià)CSF中的免疫球蛋白是來自血液滲透還是自身鞘內(nèi)合成。研究資料表明，Alb商值能評估血腦屏障完整性，而IgG指數(shù)和24小時(shí)IgG合成率能準(zhǔn)確反映中樞神經(jīng)系統(tǒng)的免疫功能狀態(tài)。因此，進(jìn)行腦脊液IgG、Alb商值、IgG指數(shù)和24小時(shí)IgG合成率的測定對GBS的早期診斷有重要意義。 相關(guān)的臨床研究發(fā)現(xiàn)，腦脊液免疫指標(biāo)水平可能與GBS病情嚴(yán)重程度相關(guān)。在疾病的早期分析其主要特點(diǎn)以及預(yù)測病情的嚴(yán)重程度，利于對患者采取積極治療，對降低其致殘率、病死率有積極的指導(dǎo)意義�，F(xiàn)將我院2012年6月至2014年2月期間住院治療的有完整病歷資料的60例GBS患者信息進(jìn)行臨床分析，并將其分為輕型和重型兩組，總結(jié)臨床特征和腦脊液免疫指標(biāo)等特點(diǎn)；對比分析其異同；旨在篩選出預(yù)測GBS患者病情嚴(yán)重程度的相關(guān)因素，以指導(dǎo)臨床醫(yī)生對其進(jìn)行早期干預(yù)和治療。 資料與方法 收集2012年6月至2014年2月期間在鄭州大學(xué)第一附屬醫(yī)院進(jìn)行住院治療的有完整病歷資料的60例GBS患者信息。將GBS患者按Hughes評分標(biāo)準(zhǔn)分為輕重兩組：輕型GBS組Hughes評分在1～3分之間，重型GBS組Hughes評分在4～6分之間。 應(yīng)用統(tǒng)計(jì)學(xué)軟件SSPS17.0分析比較兩組患者臨床特點(diǎn)和腦脊液免疫指標(biāo)的水平有無顯著性差異。定量資料用均數(shù)±標(biāo)準(zhǔn)差表示，兩組定量資料采用兩獨(dú)立樣本的t檢驗(yàn)進(jìn)行比較，定性資料采用卡方檢驗(yàn)進(jìn)行比較。P＜0.05為顯著性差異，表示有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.60例GBS患者，其中輕型35例，重型25例，重型GBS組的患者在性別、年齡、前驅(qū)事件、肌電圖分型的構(gòu)成上與輕型GBS組相比無顯著性差異（P＞0.05）。 2.重型GBS組腱反射消失患者所占比例明顯高于輕型GBS組，有顯著性差異（P＜0.05）。 3.重型GBS組治療有效患者所占比例明顯低于輕型GBS組，呼吸肌麻痹組患者治療有效患者所占比例明顯低于無呼吸肌麻痹組患者，兩者均有顯著性差異（P＜0.05）。 4.重型GBS組患者腦脊液蛋白平均值、Alb商值平均值與輕型GBS組相比無顯著性差異（P＞0.05）。 5.重型GBS組患者腦脊液IgG、IgG指數(shù)平均值、24小時(shí)IgG合成率平均值明顯高于輕型GBS組，有顯著性差異（P＜0.05）。 結(jié)論 1.GBS患者的性別，年齡，發(fā)病前有無前驅(qū)事件，肌電圖不同分型均與其病情嚴(yán)重程度無顯著相關(guān)性。 2.重型GBS組患者、呼吸肌麻痹組患者治療有效率低于輕型GBS組及無呼吸肌麻痹組。 3.GBS患者腱反射減弱程度、腦脊液中IgG增加程度、IgG指數(shù)增高程度、24小時(shí)IgG合成率增加程度和患者病情嚴(yán)重程度呈正相關(guān)。
[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.
【學(xué)位授予單位】：鄭州大學(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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