Serial electrophysiological findings in Guillain-Barr syndrome not fulfilling AIDP or AMAN criteria
Serial electrophysiological findings in Guillain-Barr syndrome not fulfilling AIDP or AMAN criteria
复制标题
格林-巴尔综合征的系列电生理学结果不符合 AIDP 或 AMAN 标准
DOI：
10.1007/s00415-016-8192-2
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发表时间：
2016
期刊：
影响因子：
6
通讯作者：
Hanafusa T.
中科院分区：
文献类型：
--
作者：
Hosokawa T;Nakajima H;Unoda K;Yamane K;Doi Y;Ishida S;Kimura F;Hanafusa T.
格林-巴勒综合征（GBS）分为两种主要亚型：急性炎症性脱髓鞘多神经病变（AIDP）和急性运动轴索神经病变（AMAN）。然而，由于电生理结果不符合AIDP或AMAN标准，一部分患者的电生理未分类，并且未分类患者的潜在病理生理机制和病变分布未得到很好的定义。本研究的目的是阐明未分类患者的疾病病理生理和病变分布。我们回顾性研究了48例连续的GBS患者。根据Ho’s标准，根据初始电生理结果对患者进行分类。对未分类患者进行临床和系列电生理检查。12例（25%）GBS患者未分类。所有未分类的患者在发病后21天能够独立行走。除1例糖尿病患者外，未见有感觉神经受累。8名患者在最初研究的15天内接受了随访研究。与初始研究相比，左正中运动神经远端运动潜伏期（dml）显著且均匀降低（p= 0.008）。所有神经的dml （p< 0.0001）和远端复合动作电位（CMAP）持续时间（p= 0.002）均显著降低，远端复合动作电位（CMAP）振幅（p= 0.026）均显著升高。在未分类的GBS患者中，与未受GBS影响的同一患者相比，初始电生理研究期间的DML值会延长，随后随着远端CMAP振幅的增加而迅速改善，而不会出现过度的时间弥散。病变也存在于远端神经节引起的可逆传导失败。
Guillain–Barré syndrome (GBS) is categorized into two major subtypes: acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). However, a proportion of patients are electrophysiologically unclassified because of electrophysiological findings that do not fulfil AIDP or AMAN criteria, and underlying pathophysiological mechanisms and lesion distributions of unclassified patients are not well defined. The aims of this study are to elucidate disease pathophysiology and lesion distribution in unclassified patients. We retrospectively studied 48 consecutive GBS patients. Patients were classified on the basis of initial electrophysiological findings according to Ho’s criteria. Clinical and serial electrophysiological examinations of unclassified patients were conducted. Twelve (25 %) GBS patients were unclassified. All unclassified patients were able to walk independently at 21 days after onset. No unclassified patients, except one patient with diabetes mellitus, had sensory nerve involvement. Eight patients underwent a follow-up study within 15 days of the initial study. Distal motor latencies (DMLs) of the left median motor nerve were found to be significantly and uniformly decreased compared with initial studies (p= 0.008). DMLs (p< 0.0001) and distal compound action potential (CMAP) durations (p= 0.002) of all nerves were significantly decreased, and distal CMAP amplitudes (p= 0.026) significantly increased compared with initial studies. In unclassified GBS patients, DML values during initial electrophysiological studies would be prolonged compared with expected values in the same patient unaffected by GBS and later improve rapidly with increased distal CMAP amplitudes without the development of excessive temporal dispersions. Lesions are also present in distal nerve segments caused by reversible conduction failure.