The Analysis Of Related Factors For Prognosis Of Guillain Barre Syndrome

Objective: Analyze the clinical,electrophysiological and biochemical features in hospitalized patients with Guillain-Barre Syndrome and explore the relevant factors of clinical prognosis.Correlative factors of a prolonged recovery in Patients with GBS were followed-up and analyzed.Method: Retrospective investigation and analysis were carried out in 144 patients with GBS in department of neurology from June 2006 to June 2016.The data including clinical,electrophysiological,and biochemical features.Patients divided into two groups based on ΔHughes between hospitalization and discharge: the good prognosis group(ΔHughes<0)and poor prognosis group(ΔHughes≥0).We analyzed the clinical,biochemical,electrophysiological data as well as immunotherapy for each group,compared prognosis among the two groups.To explore the relevant predict factors of poor prognosis by multivariable logistic model.98 patients with GBS were followed-up at their 3and 6 months from June 2014 to June 2016.Patients was divided into two groups based on recovery phase: the rapid recovery group(recover phase ≤6 months)and slow recovery group(recover phase﹥6 months).We analyzed the clinical,biochemical and electrophysiological data for each group,compared recovery phase among the two groups.To explore the relevant predict factors of slow recovery by multivariable logistic model.Results: A total of 144 patients were reviewed retrospectively,including male 89 examples and female 55 examples,with a mean age of 46.24±16.07 years.109 patients with a good prognosis,accounting for 75.69%;35 patients with a poor prognosis,accounting for 24.31%.Univariate analysis of prognosis suggested there was no significant difference in age,sex,proceeding infection,onset seasons,hypertension,type 2 diabetes,muscular dystrophy,cranial nerve involvement,autonomic nerve dysfunction,pneumonia,mechanical ventilation,course before admission cerebrospinal fluid protein,immunoglobulin G,IgG-index,intrathecal IgG synthesis rate within 24 hours and pattern on electrophysiological assessments(all P>0.05),comorbid immune disease,duration is more than 2 weeks before admission,and without elevated blood IgG are significantly associated with poor clinical outcome(all P < 0.05).Multiple factor analysis revealed that age over 55 years(P=0.03,OR=4.03,95%CI:1.16-14.01),comorbid immune disease(P=0.04,OR=8.37,95%CI:1.16-60.28),mechanical ventilation(P=0.02,OR=24.74,95%CI:1.81-339.19)are significantly associated with poor clinical prognosis.Duration is less than 2 weeks before admission(P﹤0.01,OR=0.06,95%CI:0.01-0.23)and the markedly elevated serum IgG levels(P=0.03,OR=0.09,95%CI:0.009-0.79)were protective factors of prognosis,which are significantly associated with good clinical prognosis.98 patients with GBS were included,of these 6 have died,2 have relapsed and 12 patients lost follow-up.Finally,78 patients were followed-up.Univariate analysis of recovery phase suggested there was no significant difference in age,sex,season,comorbid immune disease,type 2 diabetes,cranial nerve involvement,autonomic nerve dysfunction,mechanical ventilation,course before admission,serum IgG,cerebrospinal fluid IgG,cerebrospinal fluid IgG-index and intrathecal IgG synthesis rate within 24 hours(all P>0.05),Elevated CSF protein,elevated CSF QALB levels,axonal injury are significantly associated with slow recovery(all P < 0.05).Multiple factor analysis revealed that elevated CSF QALB levels(P=0.02,OR=4.39,95%CI:1.21-15.90),axonal injury(P=0.03,OR=3.52,95%CI:1.16-10.71)are significantly associated with a slow recovery.Conclusions: we can draw conclusions byretrospective analysis that the markedly elevated serum IgG level is the protective factor of prognosis.Age over 55 years,comorbid immune disease and mechanical ventilation are the independent risk factors for prosnosis.For these patients,they should be given individualized treatments,intensive observation frequently and transferred to ICU if necessary.Additionally,we can also draw conclusions by follow-up: Elevated CSF protein,elevated CSF QALB levels,axonal injury may be associated with slow recovery.Elevated CSF QALB levels,axonal injury are independent risk factors for recovery phase.For these patients,immunotherapy and rehabilitation training should be given as soon as possible to improve the nerve repair,avoiding the slow recovery.