Analysis Of Clinical Characteristics In Patients With Variant And Severe Guillain-barre Syndrome And Related Factors Of Mechanical Ventilation

Objective: To analyze the clinical features of variant and severe Guillain-Barre syndrome(GBS),and to explore hazard factors of mechanical ventilation(MV)in patients with severe GBS,and drawing a nomogram model to predict the risk of MV in patients with severe GBS,so as to provide clinical basis for individualized diagnosis and treatment of patients with variant and severe GBS.Methods: Collecting the clinical data of 339 patients with GBS treated in the Second Hospital of Lanzhou University from January 2012 to August 2020 retrospectively.According to the new diagnosis and classification of GBS in 2014,patients with GBS were divided into variant GBS group and non-variant GBS group.To analyze the epidemiological characteristics,clinical manifestations,characteristics of cerebrospinal fluid and electromyography(EMG),serological indexes and other clinical datas in patients with variant GBS in detail.Comparing the differences of clinical characteristics between the two groups.2.On the basis of the disability function score(Hughes score)at the peak of the patient’s condition,patients with non-variable GBS were divided into severe GBS group and light GBS group to compare the differences of clinical characteristics between the two groups,and analyzing the risk factors of short-term prognosis of patients with severe GBS.3.Patients with severe GBS were divided into MV group and non-MV group according to whether mechanical ventilation was performed.Firstly,to compare the clinical datas of the two groups,then the indexes with statistical differences were analyzed by multivariate logistic regression analysis after excluding collinearity,screening out the independent hazard factors of MV in patients with severe GBS,and using the R software to draw an individual line chart model to predict the risk of MV in patients with severe GBS.Results:A total of 339 patients with GBS were collected,including 66 cases of variant GBS,accounting for 19.5% of the total.The 66 patients with variant GBS included 29 cases of Miller Fisher syndrome(MFS)and its variants(43.9%),17 cases of paraparetic GBS(24.2%),14 cases of bifacial weakness with paraesthesias(19.6%),4 cases of pharyngeal–cervical–brachial weakness(6.1%),2 cases of bickerstaff brainstem encephalitis(3.0%).The clinical features of variant GBS and non-variant GBS were compared,which showed that there were significant differences in initial symptoms,proportion of elderly patients,EMG classification,cranial nerve involvement,tendon reflex and creatine kinase(CK)level between the two groups.2.There were 187 patients with severe GBS,accounting for 68.5% of all non-variant GBS.The clinical characteristics of severe GBS group and mild GBS group were compared,which showed that there were significant differences between the two groups i,the first symptom,the incidence in different age groups,the time from onset to hospitalization,the peak time of illness,complications,Cranial nerve involvement,tendon reflex,EMG type,hospitalization time,short-term prognosis and serum inflammatory indexes such as NLR,MLR,PLR,CRP,ALB,CAR,NAR,CLR.Patients with severe GBS have worse prognosis.dyspnea,high Hughes score,complications,autonomic dysfunction,glossopharyngeal vagus nerve involvement,mechanical ventilation,disappearance of tendon reflex,increase of serum CRP,CAR,NAR,CLR and decrease of ALB may be related to poor short-term prognosis in patients with severe GBS.3.Short time from onset to hospitalization,dyspnea in the first symptom,complications such as pulmonary infection,electrolyte disturbance and hypoproteinemia before MV,autonomic dysfunction,cranial nerve involvement and elevated serum levels of MLR,PLR,CRP,CAR and CLR may be the risk factors for MV in patients with severe GBS.Among them,dyspnea occurred in the first symptom,pulmonary infection before MV and elevated serum CRP were independent risk factors.The independent risk factors were incorporated into the R software to establish a nomogram model to predict the MV risk of severe GBS patients,and internal and external verification showed a good discrimination and accuracy in the R software.Conclusion:1.Compared with the clinical characteristics of patients with non-variant GBS,the incidence of elderly patients with variant GBS was lower,the first symptoms were complex and diverse,the cranial nerve was more easily involved,the change of tendon reflex was relatively less obvious,the proportion of normal type and axonal type of EMG was higher,and the level of serum CK was lower.2.There were asignificant differences in clinical characteristics between severe GBS and mild GBS,for GBS patients with senile onset,initial symptoms with dyspnea,short time from onset to hospitalization,complications,cranial nerve involvement,disappearance of tendon reflex,axonal damage and increase of CRP,CAR,NLR,MLR,PLR,NAR,CLR and decrease of ALB,we should be alert to the possibility of developing severe.3.In this study,the nomogram model for predicting the risk of MV in patients with severe GBS was established by combining clinical characteristics and serological indicators,which showed good accuracy in the R software.