中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2011年
8期
583-588
,共6页
王晓慧%邹丽萍%吴沪生%方方%吕俊兰%肖静%丁昌红%陈春红%王旭%金洪%周文敏%蔡伏雨
王曉慧%鄒麗萍%吳滬生%方方%呂俊蘭%肖靜%丁昌紅%陳春紅%王旭%金洪%週文敏%蔡伏雨
왕효혜%추려평%오호생%방방%려준란%초정%정창홍%진춘홍%왕욱%금홍%주문민%채복우
格林-巴利综合征%丙种球蛋白类%治疗效果%预后
格林-巴利綜閤徵%丙種毬蛋白類%治療效果%預後
격림-파리종합정%병충구단백류%치료효과%예후
Guillain-Barre syndrome%Gamma-globulins%Treatment outcome%Prognosis
目的 探讨不同类型儿童吉兰-巴雷综合征(GBS)的临床特点及丙种球蛋白(IVIG)的治疗效果.方法 回顾性分析了我科近5年住院诊治的108例GBS患儿,其中本组75例患儿均在急性期应用大剂量IVIG 400 mg/(kg·d)静点治疗5 d,收集患儿的临床、电生理资料和治疗效果,并对患儿病情恢复进行随访.结果 75例GBS患儿中急性运动性轴索型GBS(AMAN)34例(45.3%),急性炎症性脱髓鞘多发性神经病(AIDP)32例(42.7%),急性运动感觉性轴索型GBS(AMSAN)3例(4.0%),神经失电位型4例(5.3%),难以分类2例(2.7%).AIDP型起病达病情高峰时间明显比AMAN型长,差异有统计学意义(t=3.4042,P＜0.01);病情高峰时Hughes功能障碍评分,AIDP和AMAN型差异无统计学意义(x2=1.5997,P＞0.05).二者在呼吸肌麻痹、颅神经麻痹及植物神经症状方面差异无统计学意义;AIDP型患儿感觉障碍症状明显多于AMAN型,二者差异有统计学意义(x2=6.0475,P＜0.05).经IVIG治疗后AIDP和AMAN型肌力开始改善平均时间分别为(5.59±3.63)、(7.21±4.68)d,二者经治疗肌力开始改善时间AIDP型较AMAN型短,但差异没有统计学意义(t=-1.5702,P＞0.05);肌力提高1级所需时间AIDP和AMAN型分别为(8.88±4.39)、(12.67±8.35)d,二者经治疗肌力提高一级的时间AIDP型比AMAN短4 d左右,差异有统计学意义(t=-2.3689,P＜0.05).本组无1例死亡,随访调查的病例中AIDP型和AMAN型治疗后完全恢复时间差异无统计学意义(t=0.2041,P＞0.05).结论 AMAN型患儿临床进展速度较AIDP型快,除感觉神经受累方面AIDP型多于AMAN型患儿外,二者在肌无力严重程度、呼吸肌麻痹、颅神经麻痹及植物神经受累方面无明显差异.经IVIG治疗AIDP型临床恢复比AMAN型快,但AIDP和AMAN型长期预后无明显差异.
目的 探討不同類型兒童吉蘭-巴雷綜閤徵(GBS)的臨床特點及丙種毬蛋白(IVIG)的治療效果.方法 迴顧性分析瞭我科近5年住院診治的108例GBS患兒,其中本組75例患兒均在急性期應用大劑量IVIG 400 mg/(kg·d)靜點治療5 d,收集患兒的臨床、電生理資料和治療效果,併對患兒病情恢複進行隨訪.結果 75例GBS患兒中急性運動性軸索型GBS(AMAN)34例(45.3%),急性炎癥性脫髓鞘多髮性神經病(AIDP)32例(42.7%),急性運動感覺性軸索型GBS(AMSAN)3例(4.0%),神經失電位型4例(5.3%),難以分類2例(2.7%).AIDP型起病達病情高峰時間明顯比AMAN型長,差異有統計學意義(t=3.4042,P＜0.01);病情高峰時Hughes功能障礙評分,AIDP和AMAN型差異無統計學意義(x2=1.5997,P＞0.05).二者在呼吸肌痳痺、顱神經痳痺及植物神經癥狀方麵差異無統計學意義;AIDP型患兒感覺障礙癥狀明顯多于AMAN型,二者差異有統計學意義(x2=6.0475,P＜0.05).經IVIG治療後AIDP和AMAN型肌力開始改善平均時間分彆為(5.59±3.63)、(7.21±4.68)d,二者經治療肌力開始改善時間AIDP型較AMAN型短,但差異沒有統計學意義(t=-1.5702,P＞0.05);肌力提高1級所需時間AIDP和AMAN型分彆為(8.88±4.39)、(12.67±8.35)d,二者經治療肌力提高一級的時間AIDP型比AMAN短4 d左右,差異有統計學意義(t=-2.3689,P＜0.05).本組無1例死亡,隨訪調查的病例中AIDP型和AMAN型治療後完全恢複時間差異無統計學意義(t=0.2041,P＞0.05).結論 AMAN型患兒臨床進展速度較AIDP型快,除感覺神經受纍方麵AIDP型多于AMAN型患兒外,二者在肌無力嚴重程度、呼吸肌痳痺、顱神經痳痺及植物神經受纍方麵無明顯差異.經IVIG治療AIDP型臨床恢複比AMAN型快,但AIDP和AMAN型長期預後無明顯差異.
목적 탐토불동류형인동길란-파뢰종합정(GBS)적림상특점급병충구단백(IVIG)적치료효과.방법 회고성분석료아과근5년주원진치적108례GBS환인,기중본조75례환인균재급성기응용대제량IVIG 400 mg/(kg·d)정점치료5 d,수집환인적림상、전생리자료화치료효과,병대환인병정회복진행수방.결과 75례GBS환인중급성운동성축색형GBS(AMAN)34례(45.3%),급성염증성탈수초다발성신경병(AIDP)32례(42.7%),급성운동감각성축색형GBS(AMSAN)3례(4.0%),신경실전위형4례(5.3%),난이분류2례(2.7%).AIDP형기병체병정고봉시간명현비AMAN형장,차이유통계학의의(t=3.4042,P＜0.01);병정고봉시Hughes공능장애평분,AIDP화AMAN형차이무통계학의의(x2=1.5997,P＞0.05).이자재호흡기마비、로신경마비급식물신경증상방면차이무통계학의의;AIDP형환인감각장애증상명현다우AMAN형,이자차이유통계학의의(x2=6.0475,P＜0.05).경IVIG치료후AIDP화AMAN형기력개시개선평균시간분별위(5.59±3.63)、(7.21±4.68)d,이자경치료기력개시개선시간AIDP형교AMAN형단,단차이몰유통계학의의(t=-1.5702,P＞0.05);기력제고1급소수시간AIDP화AMAN형분별위(8.88±4.39)、(12.67±8.35)d,이자경치료기력제고일급적시간AIDP형비AMAN단4 d좌우,차이유통계학의의(t=-2.3689,P＜0.05).본조무1례사망,수방조사적병례중AIDP형화AMAN형치료후완전회복시간차이무통계학의의(t=0.2041,P＞0.05).결론 AMAN형환인림상진전속도교AIDP형쾌,제감각신경수루방면AIDP형다우AMAN형환인외,이자재기무력엄중정도、호흡기마비、로신경마비급식물신경수루방면무명현차이.경IVIG치료AIDP형림상회복비AMAN형쾌,단AIDP화AMAN형장기예후무명현차이.
Objective To study the clinical characteristics and effects of immunoglobulin treatment hospitalized for GBS were retrospectively analyzed; 75 cases in this group were given acute high dose of gamma globulin(IVIG)400mg/(kg·d)intravenously for 5d.Clinical and electrophysiological data and information on treatment and recovery of the children were collected during the follow-up and were analyzed.Result According to the clinical and electrophysiologic findings, 32 patients manifested acute inflammatory demyelinating polyradiculoneuropathy( AIDP), 34 had acute motor axonal neuropathy( AMAN), 3 had acute motor and sensory axonal neuropathy (AMSAN), 4 were inexcitable, 2 were unclassified. The clinical progress of the AMAN was faster than the AIDP group. Except for sensory nerve involvement, there was no significant difference in the clinical feature and severity. The mean time of the muscle strength began to recover was (5.59 +3.63) days in the AIDP group and (7. 21 ±4.68) days in the AMAN group after IVIG treatment. The time of the AIDP group was shorter than the AMAN group, but the difference was not statistically significant ( t = - 1. 5702, P ＞ 0. 05 ). The mean time of the muscle strength increased one grade was (8.88 ±4. 39) days in the AIDP group and ( 12. 67 ±8. 35) days in the AMAN group. The difference was statistically significant ( t = - 2. 3689, P ＜ 0. 05 ). No patients in this group died. Follow-up data showed that the complete recovery time was not significantly different ( t = 0. 2041, P ＞ 0. 05 ). Conclusion The clinical progress of the AMAN was faster than the AIDP group. Besides sensory nerve involvement,there was no significant difference in the clinical feature and severity. The AIDP group's clinical recovery was faster than AMAN's after the immunoglobulin treatment. The two groups were not significantly different in long-term prognosis.
