儿童吉兰-巴雷综合征极早期和早期神经电生理特征的研究

Very-early and early neuroelectrophysiological features of childhood Guillain-Barré syndrome

摘要:

目的 探讨儿童吉兰-巴雷综合征（Guillain-Barré syndrome，GBS）极早期和早期神经电生理特征，以及其与临床诊断间的关系。 方法 回顾性分析43例GBS患儿的神经电生理资料，根据检查时间分为极早期检查GBS组（起病至神经电生理检查时间≤7 d，18例）和早期检查GBS组（7 d<起病至神经电生理检查时间≤14 d，25例），同期选取与GBS患儿检查时间相匹配的急性弛缓性麻痹患儿为相应对照组，比较各组患儿神经电生理指标异常率。根据神经电生理H反射结果，将GBS患儿分为H反射异常组（34例）和H反射正常组（9例），比较2组患儿临床资料的差异。 结果 极早期检查GBS组和早期检查GBS组中H反射异常率高于相应对照组（P<0.05），而F波异常率、运动神经末端传导异常率和感觉神经传导异常率差异无统计学意义（P>0.05）。H反射异常组起病至确诊时间短于H反射正常组（P<0.05）。 结论 H反射缺失为GBS患儿早期病程中有价值的神经电生理异常指标，可协助GBS诊断。 ［中国当代儿科杂志，2022，24（9）：979-983］

Abstract:

Objective To study the very-early and early neuroelectrophysiological features of childhood Guillain-Barré syndrome (GBS) and their association with clinical diagnosis. Methods A retrospective analysis was performed on the neuroelectrophysiological data of 43 children with GBS. According to the interval from onset to neuroelectrophysiological examination, the children were divided into a very-early examination group with 18 children (an interval from onset to the examination of ≤7 days) and an early examination group with 25 children (an interval from onset to the examination of 7 to ≤14 days). The children with acute flaccid paralysis, matched for the examination time of GBS children, were enrolled as the control group. The abnormal rates of neuroelectrophysiological parameters were compared between the above groups. According to the results of the H reflex test, the GBS children were divided into an abnormal H reflex group and a normal H reflex group, and related clinical data were compared between the two groups. Results Compared with the control group, the very-early and early examination groups had a significantly higher abnormal rate of H reflex (P<0.05), while there was no significant difference in the abnormal rates of F wave, motor nerve conduction, and sensory nerve conduction (P>0.05). Compared with the normal H reflex group, the abnormal H reflex group had a significantly shorter interval from onset to the time of confirmed diagnosis (P<0.05). Conclusions Absence of the H reflex is a valuable parameter of neuroelectrophysiological abnormalities in the early stage of GBS and can help with the diagnosis of GBS. Citation:Chinese Journal of Contemporary Pediatrics, 2022, 24(9): 979-983