湖北省吉兰-巴雷综合征的分布特点及Brighton标准的价值

目的关于我国南方吉兰-巴雷综合征(GBS)的流行病学资料较少,本文旨在分析湖北省GBS的分布特点,并验证Brighton标准的诊断价值。方法收集、整理并回顾性分析2013年1月1日至2016年9月30日4年期间,湖北省内45家医院出院诊断为GBS的病例,并对其进行Brighton诊断分级。结果共收集到GBS病例581例,男性336例,中位发病年龄51岁;发病年龄呈单峰分布,46~54岁患者最多。有前驱事件者占50.9%(296/581),其中上呼吸道感染占59%(176/296)、腹泻15%(43/296);春、夏、秋、冬各不同季节发病无差异(P=0.463);湖北省各地区GBS患者所占比例有差异(P0.001),南部更多;性别及年龄无差异(P=0.906,P=0.472);581例GBS患者中包括颅神经变异型28例、Miler-Fisher综合征57例和经典型496例;经典型GBS患者中,脱髓鞘型所占比例为43.7%,轴突型24.3%;不同亚型发病年龄差异无统计学意义。Brighton分层诊断在所有经典型496例患者中1级占31.3%、2级占52.4%、3级占12.7%和4级占3.6%;在资料完善的247例患者中分别为1级62.8%、2级36.0%、3级0%和4级1.2%。结论湖北省GBS患者的好发年龄在50岁左右,男性多于女性,无季节差异;亚型以脱髓鞘型为主,明显高于我国北方;前驱因素大多数为上呼吸道感染;Brighton标准的灵敏性较高,完善的临床资料可提高诊断分级,在医疗资源相对缺乏的地区,详尽的病史及体格检查有助于提高诊断正确率。

Distribution characteristics of Guillain-Barré syndrome in Hubei Province, China and the value of Brighton criteria

Objective To investigate the distribution characteristics of Guillain-Barré syndrome (GBS) in Hubei Province, China and the diagnostic value of Brighton criteria, since there are few epidemiological data on GBS in southern China.Methods A retrospective analysis was performed for the clinical data of patients with a discharge diagnosis of GBS from January 1, 2013 to September 30, 2016 in 45 hospitals in Hubei Province, and the Brighton criteria were used for diagnosis and grading.Results A total of 581 GBS patients (including 336 male patients) were enrolled, with a median age of onset of 51 years; the age of onset showed unimodal distribution, and the patients with an age of onset of 46-54 years accounted for the highest proportion. Of all 581 patients, 296(50.9%) had antecedent events, among whom 176(59%) had upper respiratory tract infection and 43(15%) had diarrhea. There was no significant difference in the incidence rate across seasons (P=0.463). There was a significant difference in the proportion of GBS patients across different regions of Hubei Province (P<0.001), and southern Hubei had the highest proportion. There were no significant differences in sex and age. Of all 581 GBS patients, 28 had cranial nerve variant, 57 had Miller-Fisher syndrome, and 496 had classic GBS; among the patients with classic GBS, 43.7% had the demyelinating subtype and 24.3% had the axonal subtype. There was no significant difference in age of onset between different subtypes. According to the Brighton criteria, of all patients with classic GBS, 31.3% had grade 1, 52.4% had grade 2, 12.7% had grade 3, and 3.6% had grade 4 GBS; among 247 patients with complete data, 62.8% had grade 1, 36.0% had grade 2, 0% had grade 3, and 1.2% had grade 4 GBS.Conclusions In Hubei Province, the age of onset of GBS is mainly around 50 years, and there are more male than female patients. There is no significant difference in the incidence of GBS across seasons. Demyelinating GBS is the main subtype, and there is a significantly higher proportion of patients with this subtype in Hubei than in northern China. The most common antecedent event is upper respiratory tract infection. Brighton criteria have a high sensitivity, and complete clinical data helps to improve diagnostic grading. In the regions with a lack of medical resources, a detailed medical history and physical examinations may help to improve the accuracy rate of diagnosis.