The Clinical Characteristics And Prognostic Analysis Of Severe Guillain-Barré Syndrome

Background: Severe GBS is refers to according to Hughes scores, in the courseof the disease under the muscle strength of lower limbs in level4, can not walk or todo tracheotomy or tracheal intubation for assisted respiratory patients. In recent years,predicting of severe GBS and related risk factors affecting the prognosis have beenreported, but the domestic and foreign scholars on the independent risk factors has notyet reached a consensus. In the treatment of severe GBS, there is no unified standardwith hormone therapy, Ivig therapy, plasma exchange and so on in clinic, there is noevidence-based medical evidence to compare the advantages and disadvantages ofthese approaches. In order to to identify and remove factors and the risk factors toinfluence the prognosis of GBS in the early days, make the patients could get timelyand accurate treatment, we need to analyze the clinical characteristics, treatment andprognosis of severe GBS.Research objective: Analyzing induced factors and risk factors to influence theprognosis of severe GBS, comparing the effects of different treatments on prognosis,as to explore accurate comprehensive treatment to improve the prognosis to thegreatest degree in the early days.Research methods: This study retrospectively collected from June2004toDecember2012in the first hospital of Jilin University Hospital treatment for severeGullian-Barre syndrome in patients with complete clinical data of99cases. Amongthem, between January2010and December2010,32cases of patients with severeGBS and50cases of light GBS patients in control group, compared two groups ofpatients with risk factors and clinical features.Research results:1, The epidemiological characteristics of severe GBS, such assex, season, area, precursor infection factors consistent with GBS pathogenesisregularity, was no significant difference compared with light GBS.2, With difficultiesin breathing (P <0.001) and difficulty in swallowing (P=0.001) as the starting symptoms of patients with GBS to severe GBS may need to be pay attention to,difficulties in breathing may be independent risk factors for severe GBS.3, SevereGBS can go to peak wave (P=0.001) in a short time compared with light GBS.Severe GBS is in more involvement with tongue pharynx and the vagus nerve (P <0.001), facial nerve (P=0.001), oculomotor nerve (P=0.015) and autonomic nerve(P=0.01). With more complications, such as pulmonary infection (100%) andelectrolyte disorder (100%), upper gastrointestinal bleeding (27.30%), urinary tractinfections (14.10%), vein thrombosis(5.10%) is often common. In electromyogramexamination, simple axon type (P=0.03) and undifferentiated (P=0.05) in severeGBS, normal model (P <0.001) is in light GBS.4, Risk factors of severe GBSaffecting prognosis are included: facial nerve involvement (P=0.036), the firstsymptoms of precursor infection can cough (P=0.019), diarrhea (P=0.003).Among them, the diarrhea may be independent risk factor of poor prognosis of severeGBS.5, Six months after leaving hospital: pure hormone group respectively less usefulthan pure immunoglobulin group [6(3~6) vs2(0~6)；P=0.009],hormone combineimmunoglobulin group [6(3~6) vs2(0~6)；P=0.006];One year after leaving hospital:pure hormone group respectively less useful than pure immunoglobulin group [6(2~6) vs1(0~6)；P=0.002], hormone combination immunoglobulin group [6(2~6) vs1(0~6)；P=0.001].Research conclusions:1, Severe GBS and light GBS have no differences in sex,age, season, area, undifferentiated precursor infection factors.2,Difficulties inbreathing and swallowing as the starting symptoms of patients with GBS to severeGBS may need to be pay attention to, difficulties in breathing may be independentrisk factors for severe GBS.3, Severe GBS is in more involvement with tonguepharynx and the vagus nerve, facial nerve and oculomotor nerve and autonomic nerve,which have more complications with pulmonary infection and electrolyte disorder. Inelectromyogram examination, simple axon and complicated type are common insevere GBS, normal type is common in light GBS.4, Risk factors of severe GBSaffecting prognosis are included: facial nerve involvement, the first symptoms of precursor infection can cough, diarrhea. Among them, the diarrhea may beindependent risk factor of poor prognosis of severe GBS.5, Immunoglobulin grouphas better effects than hormone group to improve prognosis of severe GBS.