Clinical Correlation Between Ganglioside Antibodies And Severe Guillain-barre Syndrome In Children

ObjectiveTo investigate the clinical correlation between ganglioside antibodies and severe childhood Guillain-Barre syndrome,and the significance of treatment and prediction of prognosis.MethodsA total of 62 children diagnosed with severe Guillain-Barre syndrome in Qilu Hospital of Shandong University and Qilu Children’s Hospital of Shandong University from January 2016 to June 2020 were collected,and their clinical data were statistically analyzed.ResultsA total of 62 children were included.There were 38 males and 24 females,aged 2-15 years,mean 7.74±3.55 years.30 children(48.4%)with positive ganglioside antibody profiles and 32 children(51.6%)with negative were detected among the 62 children.The antibody profile of anti-ganglioside antibodies(AGAs)were detected positive in 30(48.4%)patients and negative in 32(51.6%)patients.In 46 patients with AIDP,21(45.7%)were detected positive and 25(54.3%)were detected negative of antibodies.In 15 AMAN patients,9(60%)had positive and 6(40%)had negative antibodies.1 case of AMSAN had negative antibody detection.There was no significant difference in the positive rate of three types of ganglioside antibodies in children with severe Guillain Barre syndrome,and there was no difference in gender and age,The expression rates of GM1-IgG,GQ1b-IgG and GD1a-IgG in AMAN were higher than those in AIDP group(P<0.05)There was no significant difference in the incidence of prodromal symptoms,limb pain,upper limb muscle strength,autonomic nerve symptoms,cranial nerve involvement and bulbar palsy between antibody-positive and antibody-negative AIDP groups.The bulbar symptoms(respiratory involvement)(P<0.05),limb numbness(P<0.05)and lower limb muscle strength impairment(P<0.05)of antibody positive children had higher incidence than those of negative children.Compared physical examination,the incidence of tendon reflex disappearance in antibody positive group was higher than that in antibody negative group,and the difference was statistically significant(P<0.05).There was no significant difference in the rate of weakness and hyperreflexia or the incidence of ataxia between the two groups.The CSF protein of antibody positive group was significantly higher than that of antibody negative group(P<0.05).There was no significant difference in the positive rate of ESR and serum etiological detection.In terms of treatment,there was no significant difference between the two groups in the number of immunoglobulin treatment times,hormone and plasma exchange.In terms of prognosis,the improvement duration of muscle strength in antibody positive group was longer than that in negative group(P<0.05),and the lower limb muscle strength at discharge was lower than that in negative group(P<0.05).The Δ Hughes score in antibody positive group was lower than that in negative group(P<0.05),indicating poor prognosis.There was no significant difference in upper limb muscle strength at discharge.The clinical data of positive and negative AGAs in children with AMAN were compared.The comparison of clinical symptoms showed that there was no respiratory prodromal symptoms in the two groups.There was no significant difference in the incidence of lower limb and upper limb muscle weakness,autonomic nerve symptoms,3rd cranial nerve involvement and bulbar palsy(P>0.05).The incidence of 7th cranial nerve involvement in antibody positive group was higher than that in antibody negative group(P<0.05).Physical examination showed that there was no significant difference in the incidence of disappearance,weakness or hyperactivity of tendon reflex and ataxia between the two groups.There was no significant difference in the average CSF protein level,ESR and etiology detection between the two groups.In terms of treatment,there was no significant difference in muscle strength improvement duration,A Hughes score and limb muscle strength at discharge.Univariate correlation analysis showed that the ratio of 7th and 3rd cranial nerve involvement in GQ1b-IgG positive group was higher than that in GQ1b-IgG negative group(P<0.05).Conclusion1.There was no significant difference in the overall positive detection rate of ganglioside antibodies in the three types of children with severe Guillain-Barre syndrome,and there was no difference in gender or age.2.There were differences in the distribution of serum ganglioside antibodies in children with severe GBS of the two subtypes AIDP and AMAN,and the expression rates of three antibodies,GM1-IgG,GQ1b-IgG and GD1a-IgG,were higher in AMAN than in the AIDP group.3.The antibody-positive group of children with severe AIDP had a higher incidence of limb weakness,a greater degree of lower limb muscle weakness at admission,more likely to have loss of tendon reflexes,and more likely to have involvement of the medulla oblongata and sensory,with more significant elevation of cerebrospinal fluid protein,slower improvement of muscle strength,and a poorer prognosis.The incidence of the cranial nerve Ⅶ involvement is high in the antibody-positive group of children with severe AMAN.4.Children with GQ1b-IgG antibody-positive in severe AMAN were more likely to have cranial nerve involvement in pair VII(P=0.017)and pair Ⅲ(P=0.022).