Clinical Characteristics Of Guillain-barré Syndrome And Its Correlation With Blood Lipid Levels

Objective:Guillain-Barré syndrome(GBS)is a classic demyelinating disorder of the peripheral nervous system.And,cholesterol,an important component of blood lipids,plays an important role in myelin formation and regeneration.In this study,we aim to analyze the correlation between the severity of GBS and blood lipid levels,then exploring the predictive value of blood lipid levels for the severity of GBS.Methods:This study retrospectively analyzed the data of GBS patients who visited the First hospital of Jilin University from April 2016 to October 2020,including the epidemiological data,clinical symptoms,peak Hughes score,lumbar puncture and electromyography results.The laboratory tests peripheral blood samples collected on an empty stomach in the early morning of the next day,and the tests include:hypersensitive C-reactive protein,fasting glucose,albumin,and blood lipids.Hughes scale was used to assess the severity and functional impairment,and the peak Hughes score was considered as an indicator of disease severity.Patients were divided into severe group(Hughes≥3)and milder group(Hughes<3).Firstly,univariate analysis of factors affecting the severity of GBS were performed using independent samples t-test(normal distribution)or Mann-Whitney U test(non-normal distribution)or Chi.square test or Fisher’s exact test(qualitative data).Then,the significant factors in univariate analysis were included in binary logistic regression analysis for multivariate study to obtain independent influences.Finally,the best cut-off value of LDL(Low-density lipoprotein)to distinguish the severity of the disease was calculated by the receiver operating characteristic(ROC)curve,exploring the predictive value of LDL on the severity of the disease.Results:1.In our study,a total of 125 patients with GBS were included,76(61%)men with a median age of 54 and 49(39%)women with a median age of 53.The number of patients in spring,summer,autumn and winter was 27(22%),33(26%),38(30%)and 27(22%),respectively.Analysis of the etiological factors showed that before the onset of the disease,the largest number of patients had symptoms of upper respiratory infection,47(37.60%),followed by 26(20.80%)patients with symptoms of gastrointestinal infection,9(7.20%)patients with a history of ganglioside injection,and a smaller number of patients with a history of surgery and vaccination,1(0.80%)and 2(1.60%).All patients showed symptoms of limb weakness,46(36.80%)had sensory disorders,60(48.00%)showed symptoms of cranial nerve involvement,mainly manifested as ophthalmoplegia,facial palsy,choking on water,dysphagia and dysarthria,24(19.20%)involved respiratory muscles because of their more severe condition,31(24.80%)showed accelerated heart rate,sweating,abdominal distension and other autonomic symptoms,26(20.80%)were troubled by sleep disorders,and 20(16.00%)complained of symptoms of limb pain.Tendon reflexes were examined,of all,91(72.80%)with diminished tendon reflexes,26(20.80%)with absent tendon reflexes,7(5.60%)with normal tendon reflexes,and 1(0.80%)with hyperactive tendon reflexes.2.In this study,there were 30 cases in the milder group and 95 cases in the severe group.Univariate analysis of the severity of GBS showed that age,albumin,myelin involvement on electromyography,and LDL were all associated with GBS severity.Compared with the milder group,in severe group,age was older(55 vs 48,p<0.05),myelin involvement on electromyography mainly happened(p<0.05),albumin {37.95(35.76～39.85)vs 40.90(37.30～43.30),p<0.05}and LDL levels{2.13(1.61～2.53)vs 2.26(1.98～2.91),p<0.05} were lower.Then,we compared the LDL values of the two groups of GBS with different electromyography results.In GBS manifested with demyelination,there were 24 cases in the milder group with a mean LDL value of 2.76 ± 0.67 mmol/L and 57 cases in severe group with a mean LDL value of 2.45 ± 0.53 mmol/L.There was a statistical difference between the two groups(p<0.05).3.Multivariate study of the severity of GBS patients showed that LDL level was an independent factor of GBS severity,and LDL level was negatively associated with GBS severity(OR 0.349,95%CI 0.146～0.832,p=0.018<0.05).4.LDL value at 3.07 mmol/L obtained by ROC calculation was the best cut-off value for predicting GBS severity,with an area under the curve(AUC)of 0.648,95%confidence interval(95% CI)of 0.524 – 0.773,p=0.014,sensitivity of 36.7%,and specificity of 94.7%.The results of our study suggest that when LDL ≥ 3.07mmol/L predicts less severe GBS;when LDL < 3.07 mmol/L predicts more severe GBS.Conclusions:1.LDL level is an independent predictor of severity,and LDL level is negatively associated with GBS severity.2.LDL ≥ 3.07 mmol/L predicts milder disease.