Electrophysiological classification of Guillain-Barre syndrome: Clinical associations and outcome
Electrophysiological classification of Guillain-Barre syndrome: Clinical associations and outcome
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DOI：
10.1002/ana.410440512
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发表时间：
1998-11-01
影响因子：
11.2
通讯作者：
Swan, AV
中科院分区：
文献类型：
--
作者：
Hadden, RDM;Cornblath, DR;Swan, AV
我们对369例格林-巴利综合征（GBS）患者在症状发作后15天内进行了电生理和血清学检测，这些患者参加了一项比较血浆置换、静脉注射免疫球蛋白和两种治疗方法的试验。根据运动神经传导标准将患者分为五组：69%为脱髓鞘，3%为轴突，3%为不可兴奋，2%为正常，23%为可疑。10例轴突神经生理学患者中有6例（60%）既往有神经系统疾病，而其他组中有71例（20%）。抗神经节苷脂GM 1抗体存在于较高比例的患者与轴突生理或不可兴奋的神经比其他患者。48周时，最初不可兴奋神经组中死亡或无法独立行走的人数（6/12，50%）高于其他组（52/357，15%），但轴突组（1/10，10%）和脱髓鞘组（44/254，17%）之间无显著差异。342例患者中有53例（16%）的感觉动作电位和临床感觉检查均正常，这些“纯运动型GBS”患者比其他GBS患者更可能具有IgG抗神经节苷脂GM 1抗体，并且先前有腹泻，但结果相似。轴突组比其他组更可能有正常的感觉动作电位。三种治疗的结果在任何亚组（包括纯运动性GBS或既往腹泻患者）或任何神经生理学类别中均无差异。
We performed electrophysiological and serological testing within 15 days of symptom onset on 369 patients with Guillain-Barre Syndrome (GBS) enrolled in a trial comparing plasma exchange, intravenous immunoglobulin, and both treatments. Patients were classified into five groups by motor nerve conduction criteria; 69% were demyelinating, 3% axonal, 3% inexcitable, 2% normal, and 23% equivocal. Six of 10 (60%) patients with axonal neurophysiology had had a preceding diarrheal illness compared with 71 of 359 (20%) in other groups. Antiganglioside GM1 antibodies were present in a higher proportion of patients with axonal physiology or inexcitable nerves than other patients. The number dead or unable to walk unaided at 48 weeks was greater in the group with initially inexcitable nerves (6 of 12, 50%) compared with the rest (52 of 357, 15%), but was not significantly different between the axonal (1 of 10, 10%) and demyelinating (44 of 254, 17%) groups. Sensory action potentials and clinical sensory examination were both normal in 53 of 342 (16%) patients, and these "pure motor GBS" patients were more likely than other GBS patients to have IgG antiganglioside GM1 antibodies and to have had preceding diarrhea but had a similar outcome. The axonal group was more likely than other groups to have normal sensory action potentials. The outcomes in response to the three treatments did not differ in any subgroup (including patients with pure motor GBS or preceding diarrhea) or any neurophysiological category.