| Part 1 The clinical characteristics and short-term prognosis in elderly patients with Guillain-Barré syndrome: a retrospective studyObjective: To investigate the clinical characteristics and short-term prognosis of elderly patients with Guillain-Barré syndrome(GBS).Methods: We retrospectively analyzed the clinical data of adult GBS during January 2003 to December 2014.According to the age,the enrolled subjects were divided into two groups,i.e.patients ≥ 60 years(Elderly group)and those aged 18-59years(Non-elderly group).The clinical characteristics and short-term prognosis of the patients in the two groups were compared.Results: In total,535 patients were enrolled.There were 67 patients fell into the elderly group with a mean age of 69 years old;while 468 patients fell into the non-elderly group with a mean age of 39 years old.We found that the elderly patients had significantly lower incidence of antecedent infections(49.3% vs 66.2%,P <0.001).The time from onset to admission(5d vs 4d,P=0,010)and time from onset to nadir(7d vs 6d,P =0,047)were significantly longer in the elderly patients.It was noteworthy that more elderly patients were found with lymphocytopenia(55.4% vs37.3%,P =0.005),hyponatremia(25.0% vs 10.2%,P =0.001),hypoalbuminemia(9.0% vs 2.6%,P =0.019)and hyperglycemia(34.3% vs 15.2%,P<0.001).Importantly,the elderly patients had longer duration of hospitalization(17d vs 14 d,P=0.010),higher incidence of pneumonia(29.9% vs 18.8%,P =0.035)and poorer short-term prognosis(58.2% vs 42.7%,P =0.017).In patients with severe GBS,no significant differences were observed in disease severity,treatment modality,incidence of pneumonia,and duration of hospitalization between the two groups.However,more patients in the elderly group showed poor short-term prognosis(84.1% vs 63.8%,P =0.008).Further,old age(≥ 60 years)(OR=2.906,95% CI:1.174-7.194,P =0.021)and lower Medical Research Council(MRC)score at nadir(OR=0.948,95% CI: 0.927-0.969,P < 0.001)were risk factors for poor short-termprognosis in severe GBS patients.Conclusion: The clinical characteristics and short-term prognosis of elderly patients with GBS are distinct from non-elderly adults.Old age(≥ 60 years)and lower nadir MRC score serve as predictor for poor short-term prognosis in severe GBS patients.Part 2 The prognosis and residual deficits of 82 patients with Guillain-Barré syndrome: a follow-up visit studyObjective: To study the prognosis and residual deficits of Guillain-Barrésyndrome and try to identify the associated factors.Methods: We analysed the data of 82 GBS patients admitted to the department of Neurology in the First hospital of Jilin University during April 2015 to June 2016.Clinical,therapeutical,laboratory and electrophysiological data were collected.Meanwhile the data of prognosis and residual deficits were collected by telephone interview at 1,2,3,6 month after the acute attack.Results: Out of the 82 patients,the proportion of poor prognosis at 3 month and6 month respectively is 32.9% and 20.7%.The mortality rate is 7.3%(6/82).Older age(P =0.006),shorter time from onset to nadir(P <0.001),lower Medical Research Council(MRC)score at nadir(P =0.014),autonomic dysfunction involvement(P<0.001),pneumonia(p =0.001),higher level of serum Immunoglobulin G(Ig G)(P=0.003),higher level of cerebrospinal Ig G(P =0.021)and increased serum C-reactive protein(P =0.007)were associated with poor prognosis at 6 month.36 patients(43.9%)was mild GBS patients,and none of them had poor prognosis at 3 month.The improvement of Hughes Functional Grading Scale(HFGS)score at 1,2,3,6month were no significant differences in both groups(application and none application of immunoglobulin therapy)in mild patients(P >0.05).The proportion of poor prognosis in acute inflammatory demyelinating polyneuropathies(AIDP)and acute motor axonal neuropathy(AMAN)at 3,6 month,respectively,were(19.5% vs75.0%,P <0.001);(17.1% vs 31.3%,P =0.413).Out of the 76 patients(excluded 6dead patients),47 patients(61.8%)had residual deficits which mainly included fatigue(59.6%),sensory signs(36.2%),reduced muscle(25.6%).Conclusion: Approximately one fifth of GBS patients have poor prognosis at 6month.Older age,shorter time from onset to nadir,lower MRC score at nadir,autonomic dysfunction involvement,pneumonia,higher level of serum andcerebrospinal Ig G,and increased serum C-reactive protein were associated with poor prognosis.The prognosis of mild patient is good and immunoglobulin therapy has not extra benefit for mild patients.The short term prognosis of AMAN is poor.The majority of GBS patients have residual deficits. |
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