Analysis Of Sever Condition And Long-term Prognosis Of Patients With Guillain-barré Syndrome

Guillain-barre syndrome(GBS)is an acute peripheral neuropathy mediated by autoimmune responses,and Two-thirds of patients have a preceding infections within 4 weeks of onset of weakness.GBS can occur globally,both men and women can suffer,and men are more likely than women.GBS mostly presents a single-phase disease,with bilateral symmetry of limb weakness as the prominent clinical feature,which may be associated with cranial nerve damage and sensory disturbances.Most patients have milder symptoms in the early stages and may become paralyzed in bed as the disease progresses.Even with respiratory failure,critically ill patients can die in the acute phase,and the mortality rate of GBS patients can reach 7%.In recent years,although the widespread application of non-specific immunotherapy drugs or means such as human immunoglobulin and plasma exchange has significantly improved the long-term prognosis of GBS patients,there are still some patients with poor recovery in clinical practice.Studies have shown that about 14% of patients are still severely disabled after 1 year of onset,and some patients may still have uncomfortable symptoms such as paresthesia,pain and fatigue,or complaints,which seriously affect their work efficiency and quality of life.Therefore,if we can find relevant risk factors that may lead to the development of acute phase of GBS patients to severe and long-term poor prognosis,and actively intervene early in the disease,it may reduce the mortality rate of GBS patients and can greatly improve The prognosis of the patient.ObjectiveTo analysis the difference in clinical presentations and laboratory investigations between the severe and mild Guillain-Barré syndrome(GBS),and to find the predictors of severe GBS.To explore the risk factors of poor long-term outcome for patients with Guillain-Barré syndrome(GBS).MethodsAll data of 84 patients with GBS from January 2014 to June 2016 in our hospital were collected.Grouped according to the Hughes score of patients at the peak of disease condition,mild group: ?3 points,severe group: ?4 points,analysis of gender,age of onset,autonomic dysfunction,cranial nerve involvement,electrophysiological typing,nerve conduction Differences in block,and serum albumin levels between the two groups.According to the Hughes score at 1 year after onset,the patients were divided into the good outcome group(?2)and the poor outcome group(?3).The effects of gender,onset age,the Hughes score at nadir,autonomic dysfunction,cranial nerve involvements,electrophysiological classification,nerve conduction block,fasting blood glucose and serum albumin level on long-term outcome were analyzed.ResultsA total of 84 patients with GBS were eventually included,including 26 cases(31%)in the mild group and 58(69%)in the severe group.Compared with the mild group,there was a higher percentage of patients at the age of onset ? 50 years(67.2% vs 34.6%),the ratio of patients with first symptom of weakness(89.7% vs 61.5%),and the percentage of patients with reduced lymphocyte percentage(50% vs 23.1%).In the severe group,the total strength of upper promixal limbs(5.48±3.07 vs 7.76±1.82)and the total distal muscle strength(4.91±2.90 vs 7.62±1.50)were worse than those of the mild group.The rate of severe patients with onset in summer and winter was higher than in spring and autumn(67.2% vs 42.3%).Multivariate logistic regression analysis showed that the age of onset ? 50 years(P = 0.007,OR = 3.877)was a risk factor for the severity of GBS patients in the acute phase.69 patients with good outcome(82.1%)and 15 patients with poor outcome(17.9%).Compared with good outcome group,there was a higher percentage of patients with onset age ? 50 years(80% vs 52.2%),mechanical ventilation(33.3% vs 2.9%),bowel/bladder dysfunction(33.3% vs 2.9%),the Hughes score ? 4 at nadir(100% vs 62.3%),hypoalbuminemia(53.3% vs 13%),bulbar paralysis(46.7% vs 18.8%),use of glucocorticoids(40% vs 8.7%)in poor outcome group(all Ps < 0.05).Multivariate logistic regression analysis showed that onset age ? 50 years(P = 0.040,OR = 9.020),bowel/bladder dysfunction(P = 0.023,OR = 10.643),hypoalbuminemia on admission(P = 0.003,OR = 9.927),and use of glucocorticoids(P = 0.035,OR = 8.576)were risk factors of poor long-term outcome in GBS patients.ConclusionThe older age of onset,the presence of limb weakness in the first symptoms,the onset of illness in the spring,poor muscle strength of both upper limbs,and the lymphocytopenia are more common in GBS patients with severe conditions,the rate of severe patients with onset in spring was higher than in winter,among which age ? 50 years is a risk factor for severe GBS.Later onset age,bowel/bladder dysfunction,hypoalbuminemia,and application of glucocorticoids are risk factors for poor long-term prognosis in patients with GBS,which suggests the necessity for strengthening nutrition support and avoiding inappropriate immunosuppressant therapy in clinical practice.