免疫球蛋白联合鞘内注射激素治疗重症格林-巴利综合征

目的观察免疫球蛋白联合鞘内注射激素治疗重症格林-巴利综合征的疗效。方法应用Hughes量表评价疗效。结果治疗组起效时间明显短于对照组,治疗组Hughes临床分级评分改善明显优于对照组。结论免疫球蛋白联合鞘内注射激素治疗重症格林-巴利综合征可缩短病程、缓解急性期症状。     

大剂量丙种球蛋白治疗急性格林-巴利综合征临床疗效观察

观察大剂量丙种球蛋白（IvIg）静脉注射治疗急性期格林-巴利综合征的临床疗效。方法：随机将36例急性进展期格林-巴利病人分成两组,观察组在对照组治疗基础上,应用大量（IvIg）静脉注射。结果：观察组与对照组疗效相比,治愈率及进步率明显高于对照组,显效率接近对照组,肌肉恢复时间观察组中病人病程明显缩短。结论：IvIg治疗格林-巴利使用上越早,疗效越显著。能减少并发症,缩短病程,故此疗法可作为GBS的简便抢救措施。     

Guillain-Barré Syndrome Surveillance during National Influenza Vaccination Campaign,New York,USA, 2009

The New York State Department of Health (NYSDOH) collected information about hospitalized patients with Guillain-Barré syndrome (GBS) during October 2009–May 2010, statewide (excluding New York City), to examine a possible relationship with influenza A(H1N1)pdm09 vaccination. NYSDOH established a Clinical Network of neurologists and 150 hospital neurology units. Hospital discharge data from the Statewide Planning and Research Cooperative System (SPARCS) were used to evaluate completeness of reporting from the Clinical Network. A total of 140 confirmed or probable GBS cases were identified: 81 (58%) from both systems, 10 (7%) from Clinical Network only, and 49 (35%) from SPARCS-only. Capture–recapture methods estimated that 6 cases might have been missed by both systems. Clinical Network median reporting time was 12 days versus 131 days for SPARCS. In public health emergencies in New York State, a Clinical Network may provide timely data, but in our study such data were less complete than traditional hospital discharge data.     

围产期孕妇生殖道B族链球菌感染和耐药性及不良妊娠结局的研究

目的 通过分析围产期孕妇生殖道B族链球菌(GBS)的感染和耐药性及不良妊娠结局,为临床医师制定有效的预防和治疗措施提供依据.方法 2013年1月至2015年2月,对795例围产期孕妇生殖道分泌物进行GBS培养鉴定与药敏试验,并观察临床症状及不良妊娠结局,对结果进行统计学分析.结果 795例孕妇中共检出GBS携带者256例,带菌率为32.2％.＜30岁组(28.9％)与≥30岁组(42.3％)的带菌率差异具有统计学意义(x2=19.095,P＜0.01).GBS阳性者与GBS阴性者的临床症状发生率(18.8％ vs 8.0％)差异具有统计学意义(x 2=39.514,P＜ 0.01).10种抗菌药物(万古霉素、利奈唑胺、青霉素、氨苄西林、头孢曲松、呋喃妥因、左氧氟沙星、克林霉素、红霉素及四环素)耐药率分别为:0％、0％、0.6％、3.1％、6.6％、9.6％、21.9％、23.8％、29.9％及58.1％.D-抑菌圈试验阳性率为23.9％.GBS阳性组与GBS阴性组比较,胎膜早破、早产、宫内感染及新生儿感染发生率的差异均有统计学意义(P＜0.01).结论 该区围产期孕妇GBS带菌率较高,且高龄者易于感染;围产期孕妇感染GBS可增加不良妊娠结局的发生,应据药敏试验结果选择敏感性抗生素予以临床干预.     

Increased Risk for Group B Streptococcus Sepsis in Young Infants Exposed to HIV,Soweto, South Africa, 2004–2008

Although group B Streptococcus (GBS) is a leading cause of severe invasive disease in young infants worldwide, epidemiologic data and knowledge about risk factors for the disease are lacking from low- to middle-income countries. To determine the epidemiology of invasive GBS disease among young infants in a setting with high maternal HIV infection, we conducted hospital-based surveillance during 2004–2008 in Soweto, South Africa. Overall GBS incidence was 2.72 cases/1,000 live births (1.50 and 1.22, respectively, among infants with early-onset disease [EOD] and late-onset [LOD] disease). Risk for EOD and LOD was higher for HIV-exposed than HIV-unexposed infants. GBS serotypes Ia and III accounted for 84.0% of cases, and 16.9% of infected infants died. We estimate that use of trivalent GBS vaccine (serotypes Ia, Ib, and III) could prevent 2,105 invasive GBS cases and 278 deaths annually among infants in South Africa; therefore, vaccination of all pregnant women in this country should be explored.     

Acceptability of a hypothetical group B strep vaccine among pregnant and recently delivered women

Objective

Group B Streptococcus (GBS) causes significant infant morbidity and mortality. Promising GBS vaccines are currently in clinical trials. Because GBS vaccines would be the first to specifically target pregnant women, we sought to assess acceptability of a hypothetical GBS vaccine.

Study design

We performed an internet survey among currently pregnant or recently delivered women receiving care at one of 9 Ob/Gyn practices in Colorado. Vaccine acceptability was assessed using questions based on constructs from the Health Belief Model. Multivariable analyses assessed the characteristics associated with GBS vaccine acceptability during the current/recent pregnancy.

Results

The response rate was 50% (n = 231). While 78% agreed that a GBS vaccine would be a good way to protect newborns, 90% and 83% agreed, respectively, that they worried generally about the safety and effectiveness of new vaccines. Moreover, 39% believed it is generally dangerous for pregnant women to get vaccines. Seventy nine percent ‘definitely’ or ‘probably’ would have gotten a GBS vaccine in their most recent pregnancy if available. The most influential factors associated with this outcome were a strong belief in the vaccine's benefits (adjusted odds ratio [AOR] 6.37, 95% confidence interval [CI] 2.01–20.16), and low perceived barriers to vaccination (AOR 0.11, 95% CI (0.03–0.37)).

Conclusion

A GBS vaccine may be acceptable to pregnant women but would benefit from strong provider support and education about the risks and consequences of GBS infection and the benefits to vaccination.     

丙种球蛋白联合甲泼尼松龙治疗小儿吉兰－巴雷综合征呼吸肌麻痹的临床研究

目的：研究丙种球蛋白联合甲泼尼松龙治疗小儿吉兰－巴雷综合征（GBS ）呼吸肌麻痹的临床疗效,企为临床治疗此病提供更有效的方法。方法：从在我院进行治疗的小儿GBS呼吸肌麻痹患者中,选取64例患者,并签订知情协议书。按照是否具有使用丙种球蛋白治疗的经济能力将患者分为实验组和对照组。实验组使用丙种球蛋白联合甲泼尼松龙治疗,对照组单纯使用甲泼尼松龙治疗,分别观察两组患者的休斯（H ug hes ）评分、疗效和不良反应。结果：试验组患者治疗的有效率为94％,显著高于对照组的69％（ P＝0．010）;在患者接受治疗后15 d ,试验组患者的 H ug hes评分是（2．69±1．23）分,明显低于对照组患者（3．34±0．85）分（P＝0．017）,且在患者接受治疗后6个月时,实验组患者的H ug hes评分是（1．29±0．94）分,亦明显低于对照组患者的（1．87±0．76）分（ P＝0．028）;实验组不良反应的发生率为16％,而对照组不良反应的发生率为22％（ P＝0．522）,差异不具有统计学意义。结论：与单纯使用甲泼尼松龙治疗小儿GBS呼吸肌麻痹相比,使用丙种球蛋白联合甲泼尼松龙治疗的疗效更为显著,且安全性较高,有利于患者病情的早期康复。     

生殖道B群链球菌感染与胎膜早破的关系及预防

目的探讨围产期女性生殖道B群链球菌感染(guoupBstreptococcus,GBS)与胎膜早破(prematureruptureofmembrane,PROM)的关系及预防策略。方法随机选择186例孕妇,采用细菌培养鉴定法检测分离围产期女性阴道分泌物中GBS。结果186例宫颈分泌物检测出GBS58例,占31.2%,GBS( )组与GBS(-)组比较PROM发生率明显增高,有显著性差异(P<0.01)。结论提示围产期女性生殖道GBS的感染与PROM发生密切相关。因此应对产前携带GBS者做好心理护理、健康教育及早行抗生素预防治疗。     

Electrophysiological findings in immune checkpoint inhibitor-related peripheral neuropathy

ObjectiveTo report the electrodiagnostic features of immune checkpoint inhibitor (ICI)-related neuropathy.MethodsWe retrospectively reviewed clinical presentations and electrodiagnostic features of 23 patients studied after receiving immune checkpoint inhibitors (ICIs). The presentations for electrodiagnostic evaluation included an acute neuropathy or neuromuscular junction disorder. We applied established electrodiagnostic criteria for polyneuropathy and acute demyelinating neuropathy.ResultsWe identified acute demyelinating neuropathy (13 cases), axonal sensory motor neuropathy (5), pure sensory neuropathy (4) and mononeuropathy (1). 13 patients had acute demyelinating neuropathy confirmed by demonstrating demyelination in 2 or more nerves; 3 additional patients had demyelination in only one nerve. Analysis of motor nerve conduction parameters revealed demyelination involving median and ulnar nerve distal motor latencies as well as median, ulnar and peroneal nerve conduction velocities. Conduction block was found in median, ulnar and peroneal nerves. The remaining one-third patients without demyelination had acute painful axonal neuropathy. Coexisting myopathic changes (6) and neuromuscular junction dysfunction (4) were also identified.ConclusionsOur findings suggest that, while immune-mediated motor nerve demyelination is the primary underlying mechanism of ICI-related neuropathy, axonal painful neuropathy can also be an important presentation. Early recognition and effective intervention may reduce morbidity and permanent disability.SignificanceElectrophysiological studies might be useful in the evaluation of ICI-related neuropathy.