儿童格林－巴利综合征28例临床分析

摘要

Objectives To investigate the clinical features of Guillain-Barré syndrome (GBS) in children from Shen-zhen. Methods The clinical manifestations, results of electrophysiological tests and prognosis of 28 GBS patients from July 2002 to July 2012 were retrospectively analysed. Results Of 28 children, 16(57.1%) had preceding acute upper respiratory infection for 3-14 days but no patient had acute gastroenteritis. One had received HBV vaccination in 2 weeks before the onset of GBS. The peak season for GBS is spring. According to the clinical presentations and the neurophysiological results 17 patients had demyelinating neuropathy, 5 acute motor axonal neuropathy, 2 acute motor sensory axonal neuropathy, 3 Miller-fisher syndrome, and 1 polyneuritis cranialis. 14 (50.0%) patients suffered from pain in limbs which is the most nota-ble symptom in the early stage. Intravenous immune globulin (IVIG) and steroids were given during the acute phases in the majority of the patients, and assisted ventilation was performed in 2 patients due to respiratory muscle paralysis. No diffe-rence was found in Hughes scores, average hospitalization durations, and the prognosis between patients with GBS variants patients and patients with classic GBS. Conclusions Children with GBS in Shenzhen area have different clinical features.%　　目的观察深圳地区儿童格林－巴利综合征（GBS）的临床特点。方法回顾性分析2002年7月－2012年7月确诊的28例GBS患儿临床表现、神经电生理检查及预后。结果28例GBS患儿中，16例（57.1%）发病前3~14 d有呼吸道感染，发病前4周内均无腹泻史；1例患儿发病前2周内曾接种乙肝疫苗。春季（3月~5月）为发病高峰季节。根据临床表现和神经电生理检查结果分型，急性炎性脱髓鞘性多发神经病（AIDP）17例，急性运动轴索性神经病（AMAN）5例、急性运动感觉轴索性神经病（AMSAN）2例，Miller-fisher综合征（MSF）3例，多发性颅神经炎（PN）1例。疼痛是发病早期最常见症状，50.0%的病例出现不同程度的肢体疼痛。大部分病例在急性期应用了免疫球蛋白和（或）糖皮质激素，2例因呼吸肌脉痹需呼吸机辅助通气。变异型GBS（包括MSF和PN）和经典型GBS（包括AIDP、AMAN、AMSAN）反映病情严重度的Hughes评分、平均住院日、预后等的差异均无统计学意义。结论AIPD是深圳地区儿童GBS的主要类型；前驱感染以上呼吸道感染为主。