| Background:Guillain-Barre syndrome(GBS)has been discovered for hundreds of years.It is currently considered to be one of the most common diseases causing acute delayed paralysis in the world.Despite the diagnosis and the treatment of GBS making rapid progress,a large number of studies have shown that some people still have severe sequelae.At present,GBS is divided into various subtypes,The clinical characteristics and prognosis of each subtype are different,which makes it necessary for more clinical staff to identify the factors affecting the prognosis of patients as early as possible,in order to reduce the outcome of prognosis and help patients to achieve the maximum benefit.Objective:Study the clinical characteristics and prognosis of different subtypes of Guillain-Barre syndrome,meanwhile,follow up and study the related factors affecting the poor short-term recovery of GBS.Methods:1.From September 2017 to August 2019,82 patients with GBS was diagnosed in the department of neurology of huaihe hospital of Henan university and the department of neurology of Henan people's hospital were retrospectively selected as the subjects of this study.According to the diagnosis criteria of GBS in 2019,the patients were classified into acute inflammatory demyelinating polyneuropathies(AIDP),acute motor axonal neuropathy(AMAN),Miller Fisher syndrome(MFS),namely AIDP group,AMAN group,and MFS group.Age,gender,pre-infection,length of stay,the peak time of disease,whether accompanied by dyspnea,cranial nerve injury,autonomic nerve injury,Hughes Functional Grading(HFGS)score at peak of disease,laboratory indexes(fasting blood glucose,positive rate of ganglioside antibody,level of cerebrospinal fluid protein)were recorded.Statistical analysis was made on the distribution of the above indicators in various subtypes of GBS,to understand their clinical characteristics;2.The difference between the HFGS score at the peak time of disease and the HFGS score at the time of discharge(?Hughes)was divided into the group with good recovery after treatment(?Hughes > 0)and the group with poor recovery(?Hughes ? 0).Study the effect of clinical,electrophysiological and laboratory indexes on the outcome of GBS and compare the short-term recovery of three subtypes.Then,Logistitic regression was used to analyze the related risk factors of poor prognosis in GBS;3.Evaluate the HFGS scores of patients with GBS of AIDP type and AMAN type at 1,3 and 6 months after onset,decide the severity and clinical prognosis of two subtypes in different time stages,all the selected patients were followed up by telephone or outpatient appointment;32 patients with GBS were included in the second neuro-electrophysiological examination one month after onset of the disease.According to the HFGS score after one month of onset,they were entered the group with good prognosis as HFGS ? 2,and the group with poor prognosis as HFGS score > 2.Monitoring the related indexes of two times of electrophysiological examination respectively,to determine the relationship between the above indicators and clinical prognosis.Results:1.A total of 82 patients with GBS were selected,including 49 males(59.8%)and 33 females(40.2%).There were 49 cases(59.8%)in the AIDP group,24 cases(29.3%)in the AMAN group,and 9 cases(10.9%)in the MFS group.The clinical characteristics,laboratory tests were compared,and there were statistically significant differences between the groups in summer and autumn period,facial paralysis and HFGS score at the peak of disease(P<0.05).Comparing the above factors,the results show that,compared with the AIDP group,the AMAN group was more prone to summer and autumn onset,while the MFS group was more prone to have facial paralysis symptoms.Comparison of HFGS scores in three groups at peak time,it was found there was no statistical difference between the AIDP and AMAN group,but a statistical difference between the MFS group,AIDP group,and AMAN group.There were no significant differences between the three groups in gender,age,pre-infection,length of hospitalization,peak time of disease and autonomic nerve damage.2.All selected patients,39(43.9%)had poor recovery after hospitalization.The adverse factors of GBS recovery included the HFGS score at discharge(P=0.000),different treatment methods(P<0.05)and dyspnea(P=0.001).Multivariate analysis showed that hormone therapy and other general treatment were worse than IVIG treatment(P=0.015);and became independent risk factors for short-term poor recovery,dyspnea(OR=4.704,95% IC 1.142—19.383,P=0.032),and the HFGS score at discharge(OR=5.257,95% IC 2.076—13.314,P=0.000)were independent risk factors affecting the poor clinical recovery of GBS patients.3.82 patients were followed up by telephone and outpatient appointment at 1,3 and 6 months after onset,HFGS scores were evaluated.Finally,a total of 70 patients were included.In the group of different time periods,according to the mean HFGS scores of the two subtypes,the scores of HFGS in the AMAN group were higher than those in the AIDP group at 3 months and 6 months.There was a significant difference in prognosis between the two subtypes at 3 months(P=0.010)and 6 months(P=0.002),but there was no difference between AMAN group and AIDP group at 1 month.32 patients with GBS were included in the neuro-electrophysiological examination at 2-3 weeks after onset and one month after onset and then reclassified by neuro-electrophysiology.Among them,3 cases(9.4%)increased in AMAN type and 5 cases(15.7%)decreased in AIDP type.For electrophysiological indexes,Univariate correlation analysis showed that there was a significant difference between the two prognosis groups in the distribution of a 20% reduction of d CMAP at 1 month(P<0.05).which was associated with poor short-term prognosis.Conclusions:1.The AIDP type is the majority type of GBS,The incidence of AMAN is more common in summer and autumn,Facial paralysis is more likely to occur in MFS patients;2.Respiratory muscle involvement,high HFGS score after discharge and hormone therapy alone were independent risk factors for poor recovery of GBS.The short-term recovery of AIDP,AMAN,and MFS were no significantly different;3.The prognosis of AIDP was better than that of AMAN patients at 3 and 6 months;... |
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