The Change Of Lymphocyte Subsets In The Patients With Gullain-Barre Syndrome Between Pre-therapy And Post-therapy With Intravenous Immunoglobulin And Its Meaning

Objective:Guillain-Barre syndrome (GBS), an acute, immune-mediated paralytic disorder affecting the peripheral nervous system, is classified into two subtypes based on electrophysiologic and pathologic criteria, as acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). But the pathogenesis of AIDP, AMAN and the mechanism of the intravenous immunoglobulin (IVIG) curing GBS are unknown as yet. Therefore, using flow cytoanalyze methods, patients with GBS were studied for the T-lymphocyte and B-lymphocyte subsets relative counting, to analyze the relations between the change of lymphocyte subsets in the condition of the light and heavy press, and the relations between the change of lymphocyte subsets in AIDP and AMAN (two subtypes of GBS), and then, made their own controls between pre-therapy and post-therapy, to analyze the different changes of lymphocyte subsets in good curative effect and bad curative effect groups, AIDP and AMAN groups, the respiratory muscle involved and respiratory muscle not involved groups, the cranial nerve and non-cranial nerve groups and the light and heavy press groups. So this research offers evidence for further discussion about immunology pathogenesy, and the possible mechanism of curing GBS with IVIG, and the immunology bases for clinical diagnoses and therapy.Methods:(1) The case group: Chose 31 patients with GBS whose morbidity were in two weeks, and had not been cured by immunoglobulin and hormone. 28 cases underwent electrophysiological examination, being recorded motor conductive velocity (MCV), distal latency, F wave and motor evoked amplitude, and were classified into two subtypes based on the criteria made by Gao Changyu and Cornblath, as AIDP and AMAN. According to the signs and symptoms in nervous system, 29 cases were commented into 0～5 classes referencing the criteria made by Hughes. (2) The control group: Chose 20 healthy individuals, whose age and sex were matched with patients with GBS and who were free from infection and had not been cured by immune depressant. (3) The method of curatio: The patients were cured by IVIG (0.4g·kg-1·d-1) for continuous 5 days. (4) The detection of lymphocyte subsets: Tested the peripheral blood lymphocyte subsets relative counting with flow cytoanalyze in the patients with GBS between pre-therapy and post-therapy with IVIG. (5) Statistical evaluations: Using SPSS 10.0 statistical analysis software, continuous variables were described as mean±standard deviation (x±s); Tests performed were the two-sample t-test for the comparison of the two means and the compared t-test for the comparison of the means made their own controls between pre-therapy and post-therapy.α=0.05.Results: (1) Males were more than females in the morbidity of GBS (male female ratio was 4:1), and the morbidity was higher in summer and autumn. 67.74% of patients had obvious respiratory or intestinal infection. The major clinic appearance was symmetria flaccid paralysis of limbs, and cranial nerve lesion was common in theⅦ,Ⅸ,Ⅹ(41.94%). The percentage of respiratory muscle involved was 22.58%. (2) The percentage of CD4+CD29+T cell was significantly higher, while the percentage of CD4+CD45RA+T cell was lower notably (P<0.05) in GBS than in the control group;The change in AIDP group was significant (P<0.05), but there was no notable difference in AMAN group; The change in mild group and cranial nerve group compared with the control group, had no statistical significance(P>0.05), but the change in severe cases group and non-cranial nerve group was notable, and except this change the percentage of CD19+B cell was notably higher (P<0.05) than the control group in the GBS and respiratory muscle involved groups. (3) The percentage of CD8+T and CD4+CD29+T cell was significantly lower (P<0.05) after therapy, while the rate of CD4+/ CD8+T and the percentage of CD4+CD45RA+T cell increased notably (P<0.05); The change in the good curative effect group was significant, and the percentage of CD19+B and CD20+B cell was significantly lower (P<0.05) after therapy, while there was no notably change after therapy in the bad curative effect group; In AIDP group, the rate of CD4+/CD8+T and the percentage of CD4+CD45RA+T cell increased notably (P<0.05),and the percentage of CD8+T, CD4+CD29+T,CD19+B and CD20+B cell was significantly lower (P<0.05) after therapy, but there was no notably change after therapy in AMAN group; The percentage of CD4+CD29+T cell was significantly lower, while the percentage of CD4+CD45RA+T cell was higher notably (P<0.05) in the mild group and severe cases group, cranial nerve group and non-cranial nerve group, respiratory muscle involved group and respiratory muscle not involved group after therapy. (4) In this data, the significant improvement rate of IVIG curing GBS was 61.29%, and there were no death cases. (5) The score, according to Hughes, was significantly lower in GBS after therapy with IVIG (P<0.05),and also in AIDP and AMAN group, mild group and severe cases group, respiratory muscle involved group and respiratory muscle not involved group (P<0.05); The change of the score had no significant difference between the mild group and the severe cases group,and between the AIDP and AMAN group (P>0.05),but the change of the score had significant difference between respiratory muscle involved group and respiratory muscle not involved group (P<0.05).Conclusion: (1) Males were more than females in the morbidity of GBS, and the morbidity was higher in summer and autumn. The majority of patients had obvious infection history. The major clinic appearance was symmetria flaccid paralysis of limbs, and it could damage the cranial nerve and the respiratory muscle. (2) There were different degrees of changes in the lymphocyte subsets between patients with GBS in acute stage and the control group, and the change was significant in the severe cases group, non-cranial nerve group and the respiratory muscle involved group, and the change in AIDP and AMAN was different. Those differences showed that: the more severe of the condition, the more significant of the change of immunology was. And there were differences in immunology pathogenesy between AIDP and AMAN. (3) There were different degrees of changes in the T-lymphocyte and B-lymphocyte subsets between pre-therapy and post- therapy with IVIG in GBS. And the changes in the good effect group were manifest. (4) There were different degrees of changes in the lymphocyte subsets between patients in AIDP and AMAN group after therapy. (5) No mater the light and heavy press or the two different subsets, the symptom was better after treatment. The therapeutic efficacy of curing GBS with IVIG was great, and it coudle actively suppress the advancement of pathogenetic condition, and encourage the functional recovery of the nerves. Through studying the changes of the lymphocyte subsets in patients with GBS in acute stage, it offered immunology bases for approaching the immunology pathogenesy of GBS, and for presuming the mechanism of intravenous immunoglobulin curing the two subtypes of GBS for further.