Abstract:

Objective　To study the relation between electrophysiological subtypes and prognosis of patients with Guillain-Barré syndrome (GBS). Methods　One hundred and sixty-eight patients with GBS treated at Department of Neurology, Xijing Hospital from September 2020 to October 2023 were selected. According to the Hadden neurophysiological classification criteria, the patients were divided into 5 types. The follow-up score of Hughes was used as the prognosis evaluation indicator. The patients whose Hughes score was 3-6 were set as a poor prognosis group, and the patients whose score was 1-2 a good prognosis group. The observation indicators included gender, age, peak Hughes score, peak mRC score, time from onset to follow-up, cerebrospinal fluid immunoglobulin (IgG), serum anti-GM antibody, prodromal gastrointestinal infections, mechanical ventilation, significant blood pressure fluctuation, and immunoglobulin therapy. Blind follow-up was conducted on the patients through telephone, outpatient daprtment, and hospitalization. χ² test was used. Univariate and multivariate COX regressions and survival curve analysis were used to analyze the risk ratio (RR) that electrophysiological typing affected the patients' prognosis. Results　A total of 168 cases were enrolled, including 100 males and 68 females. Twenty-nine cases had poor prognosis including 8 cases who died (6 men and 2 women); 139 cases had good prognosis. There were, cases (40.48%) of axonal type, 61 cases (36.31%) of demyelinating type, 20 cases (11.90%) of unclear type, 10 cases (5.95%) of normal type, and 9 cases (5.36%) of neural denervation type. The multivariate COX proportional hazards model suggested the axonal subtype (RR=4.871, 95%CI 1.397-16.983, P=0.013), male (RR=3.295, 95%CI 1.117-9.718, P=0.031), and 40-65 years old (RR=2.565, 95%CI 1.011-6.512, P=0.047) were associated with poor outcomes. Conclusion　Axonal type is the main risk factor of poor prognosis of patients with GBS.

Key words:

Guillain-Barré syndrome, Electrophysiological typing, Prognosis

摘要：

目的　研究吉兰-巴雷综合征（GBS）患者的电生理分型及预后的关系。方法　前瞻性选取2020年9月至2023年11月在西京医院神经内科住院的GBS患者168例，按照Hadden神经电生理分型标准分为5种。以随访的Hughes评分作为预后评价指标，评分3～6分为预后不良组，评分1～2分为预后良好组。观察指标有性别、年龄、高峰期Hughes评分、高峰期mRC评分、发病至随访时间、脑脊液免疫球蛋白G（IgG）、血清抗-GM抗体、前驱期消化道感染、机械通气、血压明显波动、丙种球蛋白治疗等。通过电话、门诊、入院3种随访形式对患者进行盲法随访。采用χ²检验，通过单因素及多因素COX风险回归模型及生存曲线分析电生理分型对GBS患者预后影响的相对危险度（RR）。结果　168例GBS患者中，男100例，女68例。预后不良29例，其中死亡8例（男6例，女2例）；预后良好139例。轴索型为主要分型（40.48%，68/168），神经失电位型最少（5.36%，9/168），脱髓鞘型36.31%（61/168），不明确型11.90%（20/168），正常型5.95%（10/168）。多因素COX比例风险模型提示预后不良的独立危险因素为轴索型损伤（RR=4.871，95%CI：1.397～16.983，P=0.013）、男性（RR=3.295，95%CI：1.117～9.718，P=0.031）、年龄40～65岁（RR=2.565，95%CI：1.011～6.512，P=0.047）。结论　电生理分型中轴索型损伤为GBS患者预后不良的主要危险因素。

关键词:

吉兰-巴雷综合征, 神经电生理分型, 预后