Clinical Characteristics And Cerebrospinal Fluid Immune Indexes Of Patients With Guillain-barré Syndrome: A Retrospective Analysis

Background and PurposesGuillain-Barré syndrome (GBS), also known as acute infectiouspolyradiculoneuritis. Which is induced by factors such as infection and so on. It isautoimmune disease of central nervous system, mediated by both cell immunity andhumoral immunity. Peripheral nerve lesion is act as its main characteristic. Acuteonset, premonitory infection, symmetrical progressive exacerbation movementdisorders of limbs, GBS has many clinical features. Affected sensing system orautomatic nervous system albuminocytolgoic dissociation in cerebrospinal fluid (CSF)are main clinical features of GBS. GBS is the most common cause of acuteneuromuscular paralysis at present. GBS is one-way course of disease, during thecourse may have fluctuation. The majority of patients have good prognosis, theyultimately can achieve full recovery. There are still some patients have serioussequelae. A small number of critically ill patients are prognosis mala, who are mainlydied of respiratory failure, severe arrhythmia and other complications.At present, the exact etiology and pathogenesis is not very clear. It’s consideredthat both cellular immunologic response and humoral immunoresponse are existing inGBS patients. Except the clinical manifestations and electrophysiological data, laboratory examinations also play an important role in the diagnosis of GBS. Thechanges of electrophysiology and regular pathology are not very obvious in theincipient stage of disease. The increase of immunoglobulin G in CSF occurred earlier.Because of the blood-brain barrier(BBB), the components of the immune system can’tenter the central nervous system, central nervous system(CNS) is considered to beimmunologically privileged site. But BBB may be damaged when immune reactionhappening in CNS, so we can’t know whether the immune globulin in CSF comesfrom blood or intrathecal synthesis. Researches show that Albumin quotient canevaluate the integrity of BBB, IgG index and24-hour IgG synthesis rate can reflectthe state of CNS’s immune function. So, It’s very important for early diagnosis ofGBS to determine the CSF IgG, Albumin quotient, IgG index and24-hour IgGsynthesis rate.The clinical findings show that the immune indexes of CSF may be related to theseverity of GBS. Analysis the main features of early disease and predict its severityare beneficial for patients to be given aggressive treatment, which have a positivesignificance in reducing morbidity and mortality. We collected the informations of60GBS patients with complete medical records who were in the First Affiliated Hospitalof Zhengzhou University from June2012to February2014and divided them intomild and serious subgroups for Clinical Analysis, then summarized the characteristicssuch as clinical characteristics and cerebrospinal fluid immune indexes to contrasttheir Similarities and differences. Aimed to select the predicting factors associatedwith the severity of GBS patients, which would guide clinicians for early interventionand treatmentResource and MethodsThe informations of60GBS patients who were in the First Affiliated Hospital ofZhengzhou University from June2012to February2014were collected in the study.These patients had complete medical records. According to the severity of Hughesscore, these patients would be divided into two subgroups. The patients whoseHughes score were between1and3points, were the mild GBS subgroup. The patients whose Hughes score were between4and6points, were the serious GBSsubgroup.The statistical analysis software SSPS17.0was applied to compare the clinicalfeatures and the level of CSF immune indexes. Quantitative data were expressed by（x s）, the comparison of Quantitative data was T test, the comparison ofqualitative data was the chi-square test, value were considered significant differenceat P <0.05, which meant that there were statistically significant.Results1. There were60cases of GBS patients, including35cases of mild GBSsubgroup and25cases of serious GBS subgroup. There was no significant differencein composition of gender, age, precursor events and EMG type between twosubgroups (P>0.05).2. The rate of patients with tendon reflex disappearance in serious GBSsubgroup was significantly higher than the mild GBS subgroup, which had significantdifferences (P <0.05).3. The rate of effective treatment in serious subgroup was significantly lowerthan the mild GBS subgroup, and the rate of effective treatment in respiratorymuscular paralysis subgroup was significantly lower than the none respiratorymuscular paralysis subgroup, both of them had significant differences (P>0.05).4. The average level of CSF protein, Albumin quotient was not significantlydifferent than the mild GBS subgroup (P>0.05).5.The average level of CSF IgG, IgG index,24-hour IgG synthesis rate inserious GBS subgroup were significantly higher than the mild GBS subgroup, whichhad significant differences,(P <0.05).Conclusions1. Gender, age, precursor events, EMG type had no significant correlation withseverity in GBS patients.2. Patients in serious GBS subgroup and respiratory muscular paralysis subgroup had lower therapeutic efficacy than the mild GBS subgroup and none respiratorymuscular paralysis subgroup.3. The wanes of tendon reflex, the increased level of CSF IgG, CSF IgG indexand24-hour IgG synthesis rate were positive associated with the degree of severity inGBS patients.