创伤后吉兰-巴雷综合征三例并文献复习
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摘要
目的报告3例创伤后吉兰-巴雷综合征(GBS)的临床特点、治疗方案及预后,并结合既往相关文献进行复习,以提高临床对GBS认识程度。方法描述作者医院收治的3例创伤后GBS患者的临床资料,并于中国知网、万方中文数据库和Pubmed数据库检索2013-01-01—2018-01-01有关创伤后GBS的病例报道文献,结合文献复习进行分析,系统总结创伤后GBS的临床特征、治疗及预后。结果共检索出13篇报道共31例,纳入本研究3例共34例创伤后GBS患者。创伤至发病时间数小时至5个月,中位发病时间8d,上、下四分位数分别3d、12.5d,所有患者均有运动障碍,表现为四肢无力或双下肢无力,仅2例(5.9%)伴有感觉障碍,分别为麻木和疼痛症状,19例(55.9%)甚至出现呼吸受累,表现为呼吸费力,脑神经受累者13例(38.2%)。25例行脑脊液检查者中24例(96%)出现蛋白细胞分离现象,32例患者行肌电图检查,肌电图均有异常表现,表现为波幅或传导速度的改变。患者中12例进行血清神经节苷脂抗体检测,其中10例(83.3%)阳性。18例患者单用大剂量丙种球蛋白(IVIGs)治疗,IVIGs和血浆置换(PE)联合治疗10例,单独PE治疗者2例。成功随访的27例患者中3例(11.1%)死亡,均死于GBS急性期所致的呼吸循环衰竭,9/27例(33.3%)患者恢复至可独立行走。结论创伤后GBS多为外伤或手术后的1~2周内出现,病情多较危重,发病早期不易识别,预后较一般的GBS更差。
Objective The clinical characteristics,pathogenesis,treatment and prognosis of 3 cases of post-traumatic Guillain-Barrésyndrome(GBS)were reported and previous related literature were reviewed to improve the clinical recognition.Methods The clinical data of 3 patients with post-traumatic GBS treated in the author's hospital during the past one years was described,and reports of China national knowledge internet,Wanfang database and Pubmed of the last 5 years were retrieved.We systematically summarized the clinical features,possible mechanisms,treatment and prognosis of post-traumatic GBS.Results From January 1,2013 to January 1,2018,a total of 31 patients in 13 case reports were retrieved.There were 34 patients including 3 patients in this paper.The duration from trauma to onset was several hours to 5 months,median time 8 days and the first and third qualtile 3 dand 12.5 d.All the patients had motor symptoms,only 2 cases(5.9%)had sensory disturbance,19 cases(55.9%)even had respiratory involvement,and cranial nerve involvement presented in 13 cases(38.2%).For the auxiliary examination,the rate of cyto-albuminological dissociation in cerebrospinal fluid and the abnormality in electromyography were high,including 24/25(96%)in cerebrospinal fluid,32/32(100%)in electromyography.Only 12 cases had serum ganglioside antibody detection,of which 10 cases(83.3%)were positive.18 patients were treated with intravenous immunoglobulins(IVIGs),and only 10 cases were treated with combined IVIGs and plasma exchange(PE).In terms of outcome,death rate was11.1% in 3 cases of 27 patients due to GBS, and 9/27 patients(33.3%) recovered to walk independently.Conclusions Most post-traumatic GBS occured 1-2 weeks after the trauma/operation.Early recognition was often difficult,and its outcome was worse than that of ordinary GBS.
Objective The clinical characteristics,pathogenesis,treatment and prognosis of 3 cases of post-traumatic Guillain-Barrésyndrome(GBS)were reported and previous related literature were reviewed to improve the clinical recognition.Methods The clinical data of 3 patients with post-traumatic GBS treated in the author's hospital during the past one years was described,and reports of China national knowledge internet,Wanfang database and Pubmed of the last 5 years were retrieved.We systematically summarized the clinical features,possible mechanisms,treatment and prognosis of post-traumatic GBS.Results From January 1,2013 to January 1,2018,a total of 31 patients in 13 case reports were retrieved.There were 34 patients including 3 patients in this paper.The duration from trauma to onset was several hours to 5 months,median time 8 days and the first and third qualtile 3 dand 12.5 d.All the patients had motor symptoms,only 2 cases(5.9%)had sensory disturbance,19 cases(55.9%)even had respiratory involvement,and cranial nerve involvement presented in 13 cases(38.2%).For the auxiliary examination,the rate of cyto-albuminological dissociation in cerebrospinal fluid and the abnormality in electromyography were high,including 24/25(96%)in cerebrospinal fluid,32/32(100%)in electromyography.Only 12 cases had serum ganglioside antibody detection,of which 10 cases(83.3%)were positive.18 patients were treated with intravenous immunoglobulins(IVIGs),and only 10 cases were treated with combined IVIGs and plasma exchange(PE).In terms of outcome,death rate was11.1% in 3 cases of 27 patients due to GBS, and 9/27 patients(33.3%) recovered to walk independently.Conclusions Most post-traumatic GBS occured 1-2 weeks after the trauma/operation.Early recognition was often difficult,and its outcome was worse than that of ordinary GBS.
引文
[1]Carr K R,Shah M,Garvin R,et al.Post-traumatic brain injury(TBI)presenting with Guillain-Barre syndrome and elevated anti-ganglioside antibodies:a case report and review of the literature[J].Int J Neurosci,2015,125(7):486-492.
[2]武晓玲,郝建萍,王淑珍,等.外伤、手术及神经节苷酯相关格林巴利综合征[J].中国医药指南,2013(29):88-90.
[3]王卓群.创伤相关性吉兰-巴雷综合征的临床病例分析并文献复习[D].吉林大学,2014,21-24.
[4]倪雅凤.脑外伤术后并发急性格林-巴利综合征2例[J].实用医学杂志,2014,(23):3887.
[5]薛海霞,李文安,薛海玉,等.心脏手术后并发急性吉兰-巴雷综合征1例[J].临床合理用药杂志,2016,9(1):45.
[6]王晓红,李亮.足外伤伴吉兰-巴雷综合征1例[J].实用医药杂志,2015,32(8):713.
[7]Al-Hashel JY,John JK,Vembu P.Unusual presentation of Guillain-Barrésyndrome following traumatic bone injuries:Report of two cases[J].Med Princ Pract,2013,22(6):597-599.
[8]Landais AF.Rare neurologic complication of bariatric surgery:acute motor axonal neuropathy(AMAN),a severe motor axonal form of the Guillain Barrésyndrome[J].Surg Obes Relat Dis,2014,10(6):e85-e87.
[9]Hendawi T,Zavatsky JM.Guillain-Barrésyndrome after pelvic fracture fixation[J].Spine,2015,40(6):E372-E374.
[10]Huang S,Qi H,Liu J,et al.A rare complication of spine surgery:Guillain-Barrésyndrome[J].World Neurosurg,2015,84(3):697-701.
[11]Boghani Z,Livingston AD,Simpson EP,et al.Acute onset of Guillain-Barrésyndrome after elective spinal surgery[J].World Neurosurg,2015,84(2):376-379.
[12]Samieirad S,Khajehahmadi S,Tohidi E,et al.Unusual presentation of Guillain-Barrésyndrome after mandibular fracture treatment:A review of the literature and a new case[J].J Oral Maxillofac Surg,2016,74(1):121-129.
[13]Li X,Xiao J,Ding Y,et al.Clinical and electrophysiological features of post-traumatic Guillain-Barrésyndrome[J].BMC Neurol,2017,17(1):142.
[14]Willison HJ,Jacobs BC,van Doorn PA.Guillain-Barre syndrome[J].Lancet,2016,388(10045):717-727.
[15]Schmidt SB,Rollnik JD.Critical illness polyneuropathy(CIP)in neurological early rehabilitation:clinical and neurophysiological features[J].BMC Neurol,2016,16(1):256.
[16]Bamberger PD,Thys DM.Guillain-Barre syndrome in a patient with pancreatic cancer after an epidural-general anesthetic[J].Anesth Analg,2005,100(4):1197-1199.
[2]武晓玲,郝建萍,王淑珍,等.外伤、手术及神经节苷酯相关格林巴利综合征[J].中国医药指南,2013(29):88-90.
[3]王卓群.创伤相关性吉兰-巴雷综合征的临床病例分析并文献复习[D].吉林大学,2014,21-24.
[4]倪雅凤.脑外伤术后并发急性格林-巴利综合征2例[J].实用医学杂志,2014,(23):3887.
[5]薛海霞,李文安,薛海玉,等.心脏手术后并发急性吉兰-巴雷综合征1例[J].临床合理用药杂志,2016,9(1):45.
[6]王晓红,李亮.足外伤伴吉兰-巴雷综合征1例[J].实用医药杂志,2015,32(8):713.
[7]Al-Hashel JY,John JK,Vembu P.Unusual presentation of Guillain-Barrésyndrome following traumatic bone injuries:Report of two cases[J].Med Princ Pract,2013,22(6):597-599.
[8]Landais AF.Rare neurologic complication of bariatric surgery:acute motor axonal neuropathy(AMAN),a severe motor axonal form of the Guillain Barrésyndrome[J].Surg Obes Relat Dis,2014,10(6):e85-e87.
[9]Hendawi T,Zavatsky JM.Guillain-Barrésyndrome after pelvic fracture fixation[J].Spine,2015,40(6):E372-E374.
[10]Huang S,Qi H,Liu J,et al.A rare complication of spine surgery:Guillain-Barrésyndrome[J].World Neurosurg,2015,84(3):697-701.
[11]Boghani Z,Livingston AD,Simpson EP,et al.Acute onset of Guillain-Barrésyndrome after elective spinal surgery[J].World Neurosurg,2015,84(2):376-379.
[12]Samieirad S,Khajehahmadi S,Tohidi E,et al.Unusual presentation of Guillain-Barrésyndrome after mandibular fracture treatment:A review of the literature and a new case[J].J Oral Maxillofac Surg,2016,74(1):121-129.
[13]Li X,Xiao J,Ding Y,et al.Clinical and electrophysiological features of post-traumatic Guillain-Barrésyndrome[J].BMC Neurol,2017,17(1):142.
[14]Willison HJ,Jacobs BC,van Doorn PA.Guillain-Barre syndrome[J].Lancet,2016,388(10045):717-727.
[15]Schmidt SB,Rollnik JD.Critical illness polyneuropathy(CIP)in neurological early rehabilitation:clinical and neurophysiological features[J].BMC Neurol,2016,16(1):256.
[16]Bamberger PD,Thys DM.Guillain-Barre syndrome in a patient with pancreatic cancer after an epidural-general anesthetic[J].Anesth Analg,2005,100(4):1197-1199.