《中国康复理论与实践》

《中国康复理论与实践》 ›› 2009, Vol. 15 ›› Issue (01): 24-26.

• 专题 • 上一篇    下一篇

以多组脑神经受损为首发症状的吉兰-巴雷综合征临床特点

王庆松;李从阳;郁可;王俊;肖莉;王建   

  1. 成都军区总医院神经内科，四川成都市 610083
  • 收稿日期:2008-10-20 出版日期:2009-01-01 发布日期:2009-01-01

Features of Guillain-Barré Syndrome with Complaint of Multiple Cranial Nerves Impairments: 10 Cases Report

WANG Qing-song, LI Cong-yang, YU Ke, et al   

  1. Department of Neurology, Chengdu Military General Hospital, Chengdu 610083, Sichuan, China
  • Received:2008-10-20 Published:2009-01-01 Online:2009-01-01

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摘要： 目的 分析以多组脑神经受损为首发症状的吉兰-巴雷综合征(GBS)的临床特点。方法 回顾分析10例以多组脑神经受损为首发症状的GBS患者的临床表现、电生理检测与CSF变化特点及治疗效果。结果 本组病例均以脑神经Ⅶ、Ⅸ、Ⅹ受损为首发症状，男性患者为女性的4倍，发病年龄以18～55岁年龄段为主(8/10例)，感染的前驱症状少见，膝腱及跟腱反射均减弱或消失，4例患者存在明显的脊神经根刺激症状。病程中有4例患者行呼吸机辅助呼吸。所有患者的脑脊液均在发病3周内出现蛋白-细胞分离现象，运动神经传导速度、F波异常率分别为81.25%及94.44%。与治疗前Hughes评分（4.00±0.82）相比，采用静脉注射免疫球蛋白(IVIG)治疗2周后Hughes评分为（2.25±0.96）（P=0.012)，治疗后4周为(0.50±1.00）（P=0.000)。结论 对于不明原因的多组脑神经受损，特别是累及双侧脑神经Ⅶ、Ⅸ、Ⅹ的患者，应考虑GBS的可能；早期脑脊液及电生理检查有助于明确诊断；IVIG可作为治疗以多组脑神经受损为首发症状的GBS的首选治疗方法。

关键词: 吉兰-巴雷综合征, 脑神经, 诊断, 治疗

Abstract: Objective To investigate the clinical features of patients with multi-cranial nerves impairments as the onset of Guillain-Barré syndrome (GBS). Methods 10 patients of GBS with complaint of multiple cranial neuropathy were analyzed retrospectively. Results The cranial nerves Ⅶ, Ⅸ and Ⅹ were involved at the onset of GBS, tending to affect men rather than women (4∶1), aged of 18～55 years old (8/10), and with less the antecedent of infection. The knee and ankle jerk reflexes were minimal or absent in all the patients, and the meningeal irritation signs were observed in 4 patients. Assisted ventilation was required in 4 patients during the course of their illness. The cerebrospinal fluid (CSF) characterized with increased protein concentration but a normal cell count in 2 patients in the first week, and all the patients in the following 3 weeks. The incidence of motor conduction velocity (MCV) and F waves abnormalities of electrophysiological evaluation were 81.25% and 94.44% respectively. The Hughes scales were (4.00±0.82) before treatment, and were (2.25±0.96, P=0.012) and (0.50±1.00, P=0.000) 14 d and 28 d after intravenous immunoglobulin (IVIG). Conclusion The probability of GBS should be considered in patients with multiple cranial neuropathy, especially the cranial nerves VII, IX and X impairments without precise causes. The early electrophysiological studies and CSF examinations may be useful for diagnosis. IVIG can be preferred as an effective treatment.

Key words: Guillain-Barré syndrome (GBS), cranial nerve, diagnosis, treatment