Preceding infections, immune factors, and outcome in Guillain-Barre syndrome
Preceding infections, immune factors, and outcome in Guillain-Barre syndrome
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DOI：
10.1212/wnl.56.6.758
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发表时间：
2001-03-27
期刊：
影响因子：
9.9
通讯作者：
Toyka, KV
中科院分区：
文献类型：
--
作者：
Hadden, RDM;Karch, H;Toyka, KV
目的：验证不同既往感染对格林-巴利综合征（GBS）神经生理分型及临床特征的影响。方法：在一项多中心血浆交换和免疫球蛋白试验中，我们检测了229例GBS患者发病后7 +/- 3（平均+/- SD）天的预处理血清，检测感染、粘附分子和细胞因子受体的血清学标志物，并将其与神经生理学和临床特征进行比较。结果：近期感染空肠弯曲杆菌53例（23%），巨细胞病毒19例（8%），eb病毒4例（2%）。C、空肠感染患者比其他患者更容易出现轴突神经病变或神经不兴奋、抗神经节苷脂GM、抗体、纯运动GBS、脑脊液蛋白降低和预后较差的神经生理标准。巨细胞病毒感染患者年龄更小，血清中T淋巴细胞活化和迁移的重要分子、可溶性细胞间粘附分子-1 （sICAM-1）的浓度比其他患者更高。可溶性血管细胞粘附分子-1 （sVCAM-1）、可溶性白细胞选择素和可溶性白细胞介素-2受体（sIL-2R）。神经不兴奋患者的sICAM-1和可溶性肿瘤坏死因子受体的浓度高于脱髓鞘神经生理患者。Logistic回归分析显示，48周死亡或无法独立行走与腹泻、神经不兴奋、严重手臂无力、年龄超过50岁、sIL-2R浓度升高和缺乏免疫球蛋白（Ig） M抗神经节苷脂GM抗体有关。结论：以往感染定义的GBS亚型仅与临床、神经生理和免疫特征的不同模式近似相关。单一感染因子在GBS中引起不止一种类型的病理，这意味着与其他宿主因子相互作用。大多数患者未发现感染。
Objective: To test the hypothesis that different preceding infections influence the neurophysiologic classification and clinical features of Guillain-Barre syndrome (GBS). Methods: We tested pretreatment sera, 7 +/- 3 (mean +/- SD) days from onset, from 229 patients with GBS in a multicenter trial of plasma exchange and immunoglobulin, for serological markers of infection, adhesion molecules, and cytokine receptors, and compared these with neurophysiologic and clinical features. Results: Recent infection by Campylobacter jejuni was found in 53 patients (23%), cytomegalovirus in 19 (8%), and Epstein-Barr virus in four (2%). Patients with C, jejuni infection were more likely than others to have neurophysiologic criteria of axonal neuropathy or inexcitable nerves, antiganglioside GM, antibodies, pure motor GBS, lower CSF protein, and worse outcome, Patients with cytomegalovirus infection were younger and more likely than others to have raised serum concentrations of molecules important in T lymphocyte activation and migration, soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble leukocyte selectin, and soluble interleukin-2 receptor (sIL-2R). Concentrations of sICAM-1 and soluble tumor necrosis factor receptor were higher in patients with inexcitable nerves than those with demyelinating neurophysiology. Logistic regression analysis showed death or inability to walk unaided at 48 weeks were associated with diarrhea, inexcitable nerves, severe arm weakness, age over 50, raised sIL-2R concentration and absence of immunoglobulin (Ig) M antiganglioside GM, antibodies. Conclusions: Subtypes of GBS defined by preceding infections were only approximately associated with different patterns of clinical, neurophysiologic, and immunologic features. A single infectious agent caused more than one type of pathology in GBS, implying interaction with additional host factors. Most patients had no identified infection.