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目的研究神经电生理检查在吉兰-巴雷综合征(GBS)患儿临床严重度和预后判断中的应用及其价值。方法 2012年2月至2016年2月共有122例患儿被诊断为GBS。根据患儿Hughes评分进行病情等级划分,轻型29例,重型93例。分析两组患儿的临床症状、神经电生理检查的差异及GBS预后与神经电生理之间的关系。结果上呼吸道感染、面瘫、延髓功能障碍、机械通气与自主神经功能障碍,以及前驱感染史及F波异常等发生率在轻型与重型患儿比较,差异无统计学意义(P均>0.05)。轻型患儿腹泻、胸闷发生率及远端复合肌肉的动作电位(d CMAP)波幅异常发生率低于重型患儿,胫神经运动传导速度(MCV)与腓总神经MCV高于重型患儿,最大Hughes评分低于重型患儿,差异均有统计学意义(P<0.05,P<0.01)。预后良好患儿MCV减慢与d CMAP波幅异常发生率均低于预后较差患儿(P均<0.01)。结论神经电生理检查中MCV减慢、d CMAP波幅降低或消失、Hughes评分高等提示GBS病情恢复慢,预后差,有助于GBS病情程度及预后的判断;F波是诊断GBS的敏感指标,但并非是判断预后的良好指标。
Objective To investigate the value and application of neuroelectrophysiological tests in judging clinical severity and prognosis of Guillain-Barre syndrome (GBS) children. Methods From February 2012 to February 2016 a total of 122 children were diagnosed with GBS. According to the grading of Hughes score in children, 29 cases were light and 93 cases were heavy. The clinical symptoms, neuroelectrophysiological examination differences between the two groups of children and the relationship between GBS prognosis and neuroelectrophysiology were analyzed. Results There was no significant difference in incidence of upper respiratory tract infection, facial paralysis, medullary dysfunction, mechanical ventilation and autonomic nervous dysfunction, as well as the incidence of precursor infection and F wave abnormalities in both light and heavy children (all P> 0.05). The incidence of diarrhea and chest tightness and the abnormal amplitude of d CMAP in children with mild type A were lower than those in severe type. The MCV and MCV of the common peroneal nerve were higher in severe children than in severe children Hughes score was lower than that in severe children (P <0.05, P <0.01). The prognosis of children with MCV slowed down and abnormal d CMAP amplitude were lower than those with poor prognosis (P all <0.01). CONCLUSIONS: The MCV is slowed down and the amplitude of dCAP is decreased or disappeared in neuroelectrophysiological examination. The higher Hughes score suggests that the recovery of GBS is slow and the prognosis is poor, which may be helpful to judge the severity and prognosis of GBS. F-wave is a sensitive index to diagnose GBS, Not a good indicator of prognosis.