| Objective: This study was aimed to analyze the association between anti-ganglioside antibody subtypes and the clinical phenotypes/prognosis of Guillain-Barré syndrome,and to investigate the clinical characteristics of multiple anti-ganglioside antibody-positive Guillain-Barré syndrome and its clinical significance.At the same time,this study was aimed to verify the efficiency of anti-ganglioside antibody examination as a diagnostic test for Guillain-Barré syndrome.Methods: A total of 206 patients with suspected peripheral neuropathy in Zhongda Hospital Affiliated to Southeast University and Jiangsu Provincial People’s Hospital from January 2017 to July 2021 were collected.According to the diagnostic procedures and diagnostic criteria in the Guidelines 2019,94 patients were diagnosed with Guillain-Barré syndrome and the other 104 patients were screened out.Their clinical data,including demographic data,clinical symptoms,cerebrospinal fluid and(or)serum anti-ganglioside antibody examination results,electromyography results,clinical scale and follow-up data were retrospectively analyzed,Results: 1.Compared with the control group(24.04%),the positive ratio of anti-ganglioside antibody examination of GBS group was significantly higher(P<0.05).Its sensitivity owas64.89% and its specificity was 75.96%,the AUC of the ROC was 0.704,the Youden index was0.409(P<0.05).2.Patients with coexistence of multiple antibodies accounted for 40.1% of all antibody-positive GBS patients.Among the GBS patients with positive anti-ganglioside antibodies,the number of anti-GM1 antibodies was the largest(38 cases),and the combination of anti-GM1 antibodies and anti-GT1 a antibodies was the most frequent(8 times).3.Among all the clinical phenotype clusters of GBS,the cluster of limb weakness,sensory disturbance and tendon hyporeflexia has the strongest combination.4.The GBS patients with positive anti-ganglioside antibodies had more cases of prodromic ganglioside medication history(P<0.05),and had fewer cases of neck weakness(P<0.05).The patients who had to be transferred to the rehabilitation department or hospital after the initial hospitalization were more likely to be in the anti-ganglioside antibody positive group(P<0.05);while the patients who were discharged directly from the hospital were more likely to be in the anti-ganglioside antibodies negative group (P<0.05)5.Anti-GM1 antibody was associated with the history of prodromal diarrhea,recent surgery history and ganglioside medication history(P < 0.05).Anti-GM1 antibody itself or grouped with anti-GM1 antibody were associated with AMAN subtype(P<0.05).While the m RS at admission was not significantly different,anti-GM1 antibody positive or anti-GM1 antibody positive patients had higher follow-up m RS scores(P < 0.05).Anti-GQ1 b antibody-positive GBS patients had more ophthalmoplegia and ataxia,but less limb weakness(P<0.05).Anti-GT1 a antibody-positive GBS patients had less cases of limb weakness(25.0%)than the negative group(61.0%)(P<0.05),but more ophthalmoplegia(58.3%)(P<0.05).A total of 8 GBS patients were positive for anti-GQ1 b antibody and anti-GT1 a antibody combination,and they had more ophthalmoplegia(87.5%)(P<0.05)and bulbar palsy(62.5%)(P<0.05)and less limb weakness(12.5%)(P<0.05)than the negative ones.GBS patients positive for anti-GM1 antibody and anti-GD1 b antibody combination had more electrophysiological examination results classified as AMAN(83.3%)than the negative group(P<0.05).Conclusion: 1.Anti-ganglioside antibody examination is an effective method for the diagnosis of GBS.2.There are anti-ganglioside antibody overlapping syndrome and clinical manifestation overlapping syndrome in GBS patients at the same time,among which anti-GM1 antibody,anti-GT1 a antibody combination are the most common;the classic GBS and MFS phenotype clusters are the most common.3.Anti-GM1 antibody,anti-GD1 b antibody and their combination are related to AMAN subtype;anti-GQ1 b antibody and its combination with anti-GT1 a antibody are related to MFS and its related novel phenotypic clusters;the prognosis of GBS is related to anti-ganglioside antibody,especially when anti-GM1 antibody and anti-GD1 b antibody are positive,the prognosis is poor.4.Multiple anti-ganglioside antibody-positive GBS patients have more complex symptoms and poorer prognosis. |
