Analysis Of Clinical Characteristics Of Guillain-Barré Syndrome Mediated By Different Antibodies

Objective:A retrospective analysis of the clinical presentation,electrophys-iological c haracteristics and short-term prognosis of antibody-positive patients with Guilla in-Barré syndrome was conducted to investigate the correlation between their t ypes of antibodies and the above clinical features,to help guide clinical diagn osis and treatment and predict short-term prognosis.Methods:Detailed clinical data were collected from patients diagnosed with GBS with at least 1 positive antibody at our hospital last 2 years,and collected their clinical information.The patients were classified into axonal,demyelinating and demyelinating combined with axonal damage according to electrophysiological typing criteria,and then into AIDP,AMAN,AMSAN and MFS according to clinical and electrophysiological characteristics.The above clinical features and short-term prognosis of GBS patients with different antibody subtypes were retrospectively analyzed.Results:1.General Clinical DataA total of 74 patients,mostly male(61.8%),with a mean age of 53.2 ± 16.2years,the highest incidence in winter,and a mean length of stay of 15.7 ± 9.6 days.35 patients(47.3%)had a definite antecedent infection,with respiratory tract infection being the most common(28.4%),and clinical manifestations included motor disturbances(77%),sensory abnormalities(58.1%),autonomic dysfunction(44.7%),pain(35.1%),medullary paralysis(32.4%),and ataxia(18.9%),etc.Six patients had respiratory distress(8.1%)and three were mechanically ventilated.The neurophysiological data were complete in 70 patients.65 patients had definite peripheral nerve damage,including 34 axonal,7 demyelinating,14 demyelinating combined with axonal damage and 10 non-distinguishable types;19had AIDP,18 had AMAN,10 had AMSAN,9 had MFS and 3 had incomplete MFS.52 had positive Ig G antibodies and 46 had Ig M antibodies.The most common antibody was anti-GM1.The most common antibodies were anti-GM1 antibody(47.3%)and anti-GD1 b antibody(33.8%).The median Hughes score at the time of peak disease and at discharge was 4and 2 respectively.The effect of gender(P = 0.840)and number of antibodies(P =0.892)on severity of illness was not statistically different.Treatment on admission was mainly intravenous immunoglobulin(IVIg)(85.1%),which improved significantly(P < 0.001)on discharge after aggressive treatment.12 patients had a poor short-term prognosis and one was discharged dead.2.Analysis of the clinical features with different antibodiesThe anti-GM1 antibody-positive patients mostly had symptoms of antecedent gastrointestinal infection(P = 0.023)and were more likely to have the AIDP subtype(P = 0.008);the anti-GM2 antibody-positive patients had more symptoms of ataxia(P = 0.006)and the MFS subtype(P = 0.002)than the other antibody-positive patients,with significant sensory nerve damage on electrophysiological examination;the anti-GM3 antibody-positive patients were predominantly AMAN The anti-GM3antibody-positive patients were predominantly AMAN,and all had a good short-term prognosis;the anti-GM4 antibody-positive patients were all Ig G,with significant limb weakness,predominantly axonal damage on electrophysiology(P =0.025)and AMAN subtypes(P = 0.030).Sensory disturbances were present in 76% of patients with anti-GD1 b antibodies and were more common in AMAN subtypes(P = 0.025);patients with anti-GT1 a antibodies had predominantly medullary paralysis(P = 0.009)and ophthalmoplegia(P = 0.011)and electrophysiological axonal damage;patients with anti-GQ1 b antibodies had more mild symptoms and a good short-term prognosis;patients with anti-sulfatide Anti-sulfatide antibody positive patients had more severe cases with sensory disturbances and two cases of dyspnea,both of which resolved at discharge,and sensory nerve axonal damage on electrophysiological examination.3.Distributions of antibodies with different GBS subtypesIg G antibodies were prevalent in the AMAN and AMSAN subtypes(P = 0.005),Ig M-type antibodies were more common in the AIDP and MFS subtypes(P = 0.039),anti-GM1 antibodies were common in the AIDP(P = 0.005),and anti-GM2 antibodies were more common in the MFS subtype(P = 0.002).Anti-GM1 Ig M antibodies were more common in the AIDP group compared to the AMSAN group(P = 0.029);anti-GM2 Ig M antibodies were more common in the MFS group compared to the AMAN group(P = 0.001).Conclusions:1.In this study,the majority of GBS patients with positive antibodies were middle-aged and elderly males,with varying clinical presentations.2.Ig M and Ig G antibodies are detected with similar frequency,with anti-GM1 and anti-GD1 b antibodies being the most common,while Ig G antibodies are prevalent in AMAN and AMSAN subtypes.3.The clinical manifestations,electrophysiological characteristics and short-term prognosis of GBS mediated by different antibodies are different,which is a guideline for clinical diagnosis and prognosis.