Association between Guillain-Barré syndrome and Zika virus infection – Authors' reply
Association between Guillain-Barré syndrome and Zika virus infection – Authors' reply
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吉兰-巴利综合征与寨卡病毒感染之间的关联——作者的回复
DOI：
10.1016/s0140-6736(16)30773-5
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
F. Ghawché
中科院分区：
文献类型：
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作者：
A. Fontanet;Van;T. Dub;H. Mallet;F. Ghawché
我们感谢记者对我们将寨卡病毒与格林-巴利综合征联系起来的研究的评论。1关于对诊断格林-巴利综合征的Brighton标准的非特异性的关注，我们想强调的是，除了具有典型的临床表现外，所有患者在第一周进行测试，（42人中的37人[88%];其余5例在重症监护室）有神经传导异常，42例患者中有39例（93%）脑脊液蛋白浓度升高，42例中有16例（38%）需要重症监护，证实了疾病的客观性质和严重程度。由于入院时缺乏格林-巴利综合征病例的血液样本，我们对3个月后收集的样本进行了血清中和，从而使寨卡病毒与登革热病毒中和抗体滴度之比至少为4的经验规则不适用。在100%的病例中检测到寨卡病毒中和抗体。近期寨卡病毒感染的证据得到以下支持：93%的格林-巴利综合征患者存在寨卡病毒IgM，88%的患者在神经系统症状发作前中位6天内有寨卡病毒相容性病毒综合征病史。虽然可能存在寨卡病毒和登革热病毒IgM可能交叉反应的担忧，但大多数格林-巴利综合征患者（74%）都有针对寨卡病毒的IgM，但没有登革热病毒，没有人只有登革热病毒IgM。
We thank the correspondents for their comments on our study linking Zika virus to Guillain-Barré syndrome. 1 About the concern regarding the non-specificity of Brighton criteria for diagnosing Guillain-Barré syndrome, we would like to emphasise that besides having typical clinical manifestations, all patients tested during the first week (37 [88%] of 42; the five remaining were in intensive care) had nerve conduction abnormalities, 39 (93%) of 42 patients had increased cerebrospinal fluid protein concentrations, and 16 (38%) of 42 required intensive care, substantiating the objective nature and severity of the disease.Because of a shortage of blood samples from cases of Guillain-Barré syndrome at admission, we did seroneutralisation on samples collected 3 months later, thus making the empirical rule of a ratio of Zika to dengue virus-neutralising antibody titres of at least 4 not applicable. Zika virus-neutralising antibodies were detected in 100% of the cases. Evidence of recent Zika virus infection was supported by the presence of Zika virus IgM in 93% of patients with Guillain-Barré syndrome and a history of Zika virus-compatible viral syndrome in a median of 6 days before the onset of neurological symptoms in 88% of patients. Although concern might exist about possible cross-reactivity of Zika virus and dengue virus IgM, most patients (74%) with Guillain-Barré syndrome had IgM against Zika virus but not dengue virus, and none had only dengue virus IgM.