Clinical Features And Severe Type Associated Factors Of Guillain Barré Syndrome

Part 1 Antecedent Events and Clinical Features of Guillain Barré SyndromeBackground and objective: Infections are identified as the most common antecedent events of Guillain Barré Syndrome(GBS).Zika virus and vaccinations can also increase the risk of GBS.In addition to different potential triggers,diagnosis of GBS is mainly based on history and clinical features without effective biological markers on the early stage.Although clinical manifestations of the typical GBS and Miller-Fisher syndrome(MFS)can be more easily recognized by clinicians nowadays,their variabilities lead to the fact that none of existing classification systems could cover all the subtypes and clinical features of this complicated syndrome.Most of the large multi-center clinical researches have been done in countries of Europe,North America and other places.The diagnosis and treatment guidelines in China are as well based on literature of those countries.But,the incidence and clinical features of GBS are variable in different regions.Therefore,it is helpful to study its possible antecedent events and clinical features in Chinese population.Research methods: We collected patients diagnosed as GBS for the first time at Neurological Department of Tongji Hospital from January 2014 to August 2016,and then analyzed their antecedent events and clinical features.Research results: We collected 53 patients totally,34% of which developed GBS in winter,32.1% in summer,20.8% in spring and 13.2% in autumn.60.4% were male and the mean age of all the patients was 46 years old.Those who were older than 50 years old made up the largest part.33.9% of all the patients had an antecedent infection history such as respiratory or gastrointestinal infections and 20.8% had a trauma or surgery,compared with the fact that none of them had a history of vaccination.As for the onset symptoms,limb weakness accounted for 71.7% of the total number of cases,sensory disorders for 11.3% and cranial nerve involvement for 17.0%.During the disease course,the tendon reflexes of 88.6% of the cases diminished or disappeared,another 11.4% had normal or even increased tendon reflexes.The number of cases who had limb weakness,sensory disorders and cranial nerve damage increased compared with that at the start of the disease.According to Hughes score,there were 73.6% who belonged to severe type and 11.3% needed mechanical ventilation.About the cytoalbuminologic dissociation of cerebral spinal fluid(CSF),the positive rate in the period of the 8th to 14 th day from the onset was the highest,namely 92.0%.Among the 11 cases that had a trauma or surgery before the onset of GBS,most of them developed into severe type,manifested axonal damage according to electrophysiological examination and GM1 Ig G was found among the those who had a serum gangliosides antibody test.Conclusions: The number of GBS patients was the greatest in winter,and males were more than females.Patients older than 50 years old made up the largest part.The positive rate of cytoalbuminologic dissociation of CSF was the highest in the second week from the onset symptoms,which could mean that patients don’t need to wait for two weeks to have CSF tests.In addition to antecedent infections,trauma or surgery may trigger the onset of GBS which could easily become severe and develop into axonal damage caused by GM1 Ig G associated mechanisms.Part 2 Severe Type Associated Factors of Guillain Barré SyndromeBackground and objective: Clinical manifestations,antecedent events and the degrees of severity of Guillain Barré Syndrome(GBS)differ greatly.And the diagnosis is mainly based on antecedent history and clinical features.Therefore,it is of great importance to find out potential risk factors making the disease worse and then guide the early effective treatment,improve the efficacy and reduce the possibility of long-term disability.Here,we aimed to find the possible risk factors contributing to severe type.Research methods: We collected patients who diagnosed as GBS for the first time at Neurological Department of Tongji Hospital from January 2014 to August 2016,and then according to Hughes score divided them into the mild type(lower limb muscle strength≥4 level without mechanical ventilation)and severe type(lower limb muscle strength < 4 level or need mechanical ventilation).After that we used Chi-square test,Fisher’s exact test,t-test and Logistic regression to analyze factors such as gender,age,season,antecedent events,different onset symptoms and symptoms during the whole course.Research results: gender(P=0.773),age(P=0.348),winter(P=0.251),summer(P=0.508),spring(P=0.755),autumn(P=1.000),antecedent infections(P=0.624),surgery or trauma(P=0.755),sensory disorders as the onset symptom(P=0.919),bulbar muscle disorders(P=0.251),cranial nerve damage(P=0.075),decreased tendon reflexes(P=0.123)and Lasegue sign(P=0.309)during the course,the cytoalbuminologic dissociation of cerebral spinal fluid and protein in cerebral spinal fluid more than 1000mg/L didn’t show significant difference.On the contrary,limb weakness(P=0.014)and non-cranial nerve damage(P=0.04)as the onset symptom,and disappeared tendon reflexes(P=0.008)during the disease course had significant differences.Finally,by utilizing Logistic regression,limb weakness as the onset symptom(P=0.006,OR=10.753)and disappeared tendon reflexes during the course(P=0.009,OR=9.744)were significant for severe GBS.Conclusions: limb weakness as the onset symptom and disappeared tendon reflexes during the course may be the potential risk factors of the severe GBS,whereas,the patients with protein more than 1000mg/L in CSF have no more risk at becoming severe than those with protein under 1000mg/L.