Clinical Analysis Of Guillain-barré Syndrome In Adults And Correlation With Cerebrospinal Fluid Proteins

Objective:Guillain-Barré syndrome(GBS)is an immune-mediated inflammatory peripheral neuropathy,and cerebrospinal fluid proteins play an important role in the inflammatory mechanism of Guillain-Barré syndrome.In this study,we analyzed the clinical manifestations of Guillain-Barré syndrome(GBS)in adults and investigated the correlation between cerebrospinal fluid total proteins(CSF-TP)and GBS to provide a reference for the diagnosis,treatment and prognostic evaluation of GBS.Methods:The clinical data of 156 patients with GBS who were initially hospitalized in the Department of Neurology of the Fourth Affiliated Hospital and the First Affiliated Hospital of Nanchang University between January 1,2019 and December31,2022 were retrospectively analyzed.The patients’ age,gender,Admission and discharge dates,antecedent triggers or medical history,clinical symptoms,physical examination,electrocardiogram,cerebrospinal fluid laboratory results,neurophysiological examination,treatment plan,discharge symptoms and physical examination were included.The patients were divided into the group with mild dysfunction and the group with severe dysfunction according to their condition and muscle strength score at admission and discharge,and the general clinical data and cerebrospinal fluid protein level of the two groups were compared.Results:The 156 adult GBS patients had a slightly higher incidence of male predominant type;The epidemiology has the highest number of cases in winter,followed by summer.Age of onset: middle-aged people had the most onset,followed by the elderly,with a mean age of onset of 53 years and a median age of 53 years,consistent with the middle-aged stage;the mean number of days in hospital was 14 days.There were 49 patients(31.4%)with clear antecedent history or causative factors,among which the number of fever and upper respiratory tract infection antecedent causative factors accounted for the largest number.Clinical manifestations were most common with symmetric limb weakness,followed by sensory abnormalities;physical examination was most common with diminished or absent tendon reflexes.There were 156 cases of complete electrocardiogram examination and 48 cases(30.8%)of abnormal electrocardiogram;144 cases of complete lumbar puncture examination and 112 cases(77.8%)of abnormal cerebrospinal fluid protein,which accounted for a higher percentage;133 cases of lumbar puncture examination were performed within 4 weeks of onset,and compared with cases of lumbar puncture at onset ≤1 week and 1 week-3 weeks,the rate of cerebrospinal fluid protein-cell dissociation in cases of lumbar puncture at 3-4weeks The highest The percentage of electrophysiological motor fiber involvement was the highest,sensory fiber involvement was the second highest,and autonomic nerve involvement was the least common,and the percentage of myelin and axonal damage was approximately the same.There were 102 cases(65.4%)with severe functional impairment assessed by the Functional Disability Scale at admission and58 cases(37.2%)with severe functional impairment(poor short-term prognosis)assessed by the Functional Disability Scale at discharge.The treatment protocol was based on gammaglobulin therapy.There was a statistical difference between the group with normal and mildly high cerebrospinal fluid proteins and the group with abnormally high cerebrospinal fluid proteins in GBS cases with lumbar puncture completed within 1 week of onset,compared with the group with abnormally high cerebrospinal fluid proteins in electrophysiologically typed demyelination-dominant type and axonal damage dominant type,and with or without limb numbness,P <0.05.There was a statistical difference between the group with normal and mildly high cerebrospinal fluid proteins and the group with abnormally high cerebrospinal fluid proteins in GBS cases with lumbar puncture perfected within 1 week-4 weeks of onset,comparing the electrophysiological demyelination predominant type with the axonal damage predominant type and whether the electrocardiogram was abnormal or not,P < 0.05.Conclusion:1.The immunological diagnostic rate of the cerebrospinal fluid protein-cell separation test is higher in adult GBS patients,and the longer the duration of disease within 4 weeks of acute onset,the higher the rate of cerebrospinal fluid protein-cell separation.2.The electrophysiological demyelination-dominant type of cerebrospinal fluid protein-cell separation was more pronounced compared to the electrophysiological axonal damage dominant adult GBS.3.There was no significant relationship between cerebrospinal fluid protein levels and the severity of admission dysfunction and discharge dysfunction in adult GBS patients.