背景:建议在中度至重度格林-巴利综合征(GBS)中使用静脉免疫球蛋白(IVIg)和血浆置换(PLEX),但是缺乏评估其对神经传导研究(NCS)影响的研究。我们报告了与GBS患者的自然病程(NC)相比,IVIg和PLEX对NCS参数和临床结果的影响。
方法:根据临床纳入中重度GBS患者,脑脊液,和NCS发现。入院时评估了六个运动和感觉神经,一个月又三个月,完成了NCS分型。注意到运动神经轴突和脱髓鞘负担以及早期可逆传导阻滞(ERCB)。接受IVIg的患者,注意到PLEX或NC。结果是在完成后3个月确定的,使用0-6GBS残疾量表(GBSDS)的部分和较差的。
结果:纳入72例患者,中位年龄为36岁,女性为22岁(30.6%)。44例患者接受IVIg,9个PLEX和19个在NC中,他们有类似的峰值残疾。AIDP是入院时的主要亚型(58.3%),保持在3个月(50%)。亚型的转移在模棱两可的组中最高,其次是AMAN,而在AIDP中最少。与NC相比,IVIg和PLEX组轴突负荷减少更多,并且有ERCB。33例(44%)患者完全恢复,40例(55.5%)患者的临床和神经电生理结果一致。
结论:GBS亚型的转变可能发生在所有亚型的随访中,模棱两可组最高,AIDP组最低。IVIg/PLEX治疗可能有助于减少传导阻滞和轴突负担。
BACKGROUND: Intravenous immunoglobulin (
IVIg) and plasmapheresis (PLEX) are recommended in moderate to severe Guillain-Barré Syndrome (GBS), but there is paucity of studies evaluating its effect on nerve conduction studies (NCS). We report the effect of
IVIg and PLEX on the NCS parameters and clinical outcomes compared to natural course (NC) of GBS patients.
METHODS: Moderate to severe GBS patients were included based on clinical, cerebrospinal fluid, and NCS finding. Six motor and sensory nerves were evaluated at admission, one month and 3 months, and NCS subtyping was done. Axonal and demyelination burden in motor nerves and early reversible conduction block (ERCB) were noted. Patients receiving
IVIg, PLEX or on NC were noted. Outcome was defined at 3 months into complete, partial and poor using a 0-6 GBS Disability Scale (GBSDS).
RESULTS: Seventy-two patients were included, whose median age was 36 years and 22(30.6 %) were females. 44 patients received IVIg, 9 PLEX and 19 were in NC, and they had comparable peak disability. AIDP was the dominant subtype at admission (58.3 %), which remained so at 3 months (50 %). The shift of subtypes was the highest from the equivocal group followed by AMAN and the least from AIDP.
IVIg and PLEX group had more reduction in axonal burden and had ERCB compared to NC. 33(44 %) patients had complete recovery, and 40(55.5 %) patients had concordance in clinical and neurophysiological outcome.
CONCLUSIONS: Transition of GBS subtype may occur at follow-up from all the subtypes, the highest from the equivocal and the lowest from the AIDP group.
IVIg/PLEX treatment may help in reducing conduction block and axonal burden.