儿童吉兰-巴雷综合征交感皮肤反应的特点分析

靳梅; 刘静; 刘康; 赵力搏; 赵紫薇; 孙素真

doi:10.7499/j.issn.1008-8830.2303049

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中国当代儿科杂志 ›› 2023, Vol. 25 ›› Issue (9) : 929-935. DOI: 10.7499/j.issn.1008-8830.2303049

论著·临床研究

儿童吉兰-巴雷综合征交感皮肤反应的特点分析

靳梅, 刘静, 刘康, 赵力搏, 赵紫薇, 孙素真

作者信息 +

Characteristics of sympathetic skin response in children with Guillain-Barré syndrome

JIN Mei, LIU Jing, LIU Kang, ZHAO Li-Bo, ZHAO Zi-Wei, SUN Su-Zhen

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文章历史 +

摘要

目的探讨交感皮肤反应（sympathetic skin response, SSR）对儿童吉兰-巴雷综合征（Guillain-Barré syndrome, GBS）早期诊断及预后评估的价值。方法回顾性收集2018年10月—2022年11月收治的25例GBS患儿的临床资料，选取同期诊断为抽动障碍的30例患儿作为对照组，比较两组患儿间SSR的特点，并分析SSR与自主神经功能障碍（autonomic dysfunction, AD）、疾病严重程度及预后的关系。结果 GBS组患儿急性期SSR异常率高于对照组（P<0.001）。联合SSR和神经传导早期（发病2周内）诊断GBS的灵敏度、特异度和准确度分别为84％、100％和93％。SSR异常患儿AD比例及疾病高峰时Hughes评分与SSR正常患儿比较差异均无统计学意义（P>0.05）。短期（发病1个月）预后不良患儿SSR测定全部（7/7）异常。结论 SSR可以用于早期辅助诊断儿童GBS和监测疾病治疗情况。

Abstract

Objective To explore the value of sympathetic skin response (SSR) in the early diagnosis and prognostic evaluation of Guillain-Barre syndrome (GBS) in children. Methods A retrospective analysis was conducted on the clinical data of 25 children with GBS who were diagnosed from October 2018 to November 2022, and 30 children who were diagnosed with Tourette's syndrome during the same period were selected as the control group. The characteristics of SSR were compared between the two groups, and the association of SSR with autonomic dysfunction (AD), disease severity, and prognosis was analyzed. Results The GBS group had a significantly higher abnormal rate of SSR than the control group during the acute phase (P<0.001). SSR combined with early nerve conduction (within 2 weeks after onset) had a sensitivity of 84%, a specificity of 100%, and an accuracy of 93% in the diagnosis of GBS. There were no significant differences in the proportion of AD cases, as well as the Hughes scores during the disease peak, between the abnormal and normal SSR groups (P>0.05). All 7 children with poor short-term prognosis (at 1 month after onset) had abnormal SSR. Conclusions SSR can be used for the early diagnosis of GBS and the monitoring of treatment response in children.

导出引用

靳梅, 刘静, 刘康, 赵力搏, 赵紫薇, 孙素真. 儿童吉兰-巴雷综合征交感皮肤反应的特点分析[J]. 中国当代儿科杂志. 2023, 25(9): 929-935 https://doi.org/10.7499/j.issn.1008-8830.2303049

JIN Mei, LIU Jing, LIU Kang, ZHAO Li-Bo, ZHAO Zi-Wei, SUN Su-Zhen. Characteristics of sympathetic skin response in children with Guillain-Barré syndrome[J]. Chinese Journal of Contemporary Pediatrics. 2023, 25(9): 929-935 https://doi.org/10.7499/j.issn.1008-8830.2303049

参考文献

1 van den Berg B, Walgaard C, Drenthen J, et al. Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis[J]. Nat Rev Neurol, 2014, 10(8): 469-482. PMID: 25023340. DOI: 10.1038/nrneurol.2014.121.
2 Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome[J]. Lancet, 2021, 397(10280): 1214-1228. PMID: 33647239. DOI: 10.1016/S0140-6736(21)00517-1.
3 Zheng P, Tian DC, Xiu Y, et al. Incidence of Guillain-Barré syndrome (GBS) in China: a national population-based study[J]. Lancet Reg Health West Pac, 2022, 18: 100302. PMID: 35024648. PMCID: PMC8661041. DOI: 10.1016/j.lanwpc.2021.100302.
4 Zaeem Z, Siddiqi ZA, Zochodne DW. Autonomic involvement in Guillain-Barré syndrome: an update[J]. Clin Auton Res, 2019, 29(3): 289-299. PMID: 30019292. DOI: 10.1007/s10286-018-0542-y.
5 López-Hernández JC, Jorge de Saráchaga A, Brise?o-Godínez ME, et al. Deltoid muscle strength and autonomic dysfunction as independent risk factors for invasive mechanical ventilation in patients with Guillain-Barré syndrome[J]. Int J Neurosci, 2022. PMID: 35633066. Epub ahead of print. DOI: 10.1080/00207454.2022.2082963.
6 Kondziella D. Autonomic dysfunction in Guillain-Barré syndrome puts patients at risk[J]. Neurocrit Care, 2020, 32(1): 86-87. PMID: 31338746. DOI: 10.1007/s12028-019-00793-6.
7 林志坚, 季晓林, 周瑞玲. 皮肤交感反应及其临床应用进展[J]. 临床神经电生理学杂志, 2007, 16(3): 171-174. DOI: 10.3969/j.issn.1674-8972.2007.03.015.
8 魏易琼, 苏常春, 周倩, 等. 神经传导、F波及皮肤交感反应联合检测对糖尿病周围神经病变早期诊断的价值[J]. 华中科技大学学报(医学版), 2020, 49(4): 477-480. DOI: 10.3870/j.issn.1672-0741.2020.04.018.
9 Hu F, Jin J, Qu Q, et al. Sympathetic skin response in amyotrophic lateral sclerosis[J]. J Clin Neurophysiol, 2016, 33(1): 60-65. PMID: 26844971. DOI: 10.1097/WNP.0000000000000226.
10 Aghamollaii V, Harirchian MH, Modabbernia A, et al. Sympathetic skin response (SSR) in multiple sclerosis and clinically isolated syndrome: a case-control study[J]. Neurophysiol Clin, 2011, 41(4): 161-171. PMID: 22078728. DOI: 10.1016/j.neucli.2011.08.003.
11 Leonhard SE, Mandarakas MR, Gondim FAA, et al. Diagnosis and management of Guillain-Barré syndrome in ten steps[J]. Nat Rev Neurol, 2019, 15(11): 671-683. PMID: 31541214. PMCID: PMC6821638. DOI: 10.1038/s41582-019-0250-9.
12 Sejvar JJ, Kohl KS, Gidudu J, et al. Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data[J]. Vaccine, 2011, 29(3): 599-612. PMID: 20600491. DOI: 10.1016/j.vaccine.2010.06.003.
13 Liu S, Xiao Z, Lou M, et al. Guillain-Barré syndrome in southern China: retrospective analysis of hospitalised patients from 14 provinces in the area south of the Huaihe River[J]. J Neurol Neurosurg Psychiatry, 2018, 89(6): 618-626. PMID: 29326294. DOI: 10.1136/jnnp-2017-316930.
14 Hadden RD, Cornblath DR, Hughes RA, et al. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome[J]. Ann Neurol, 1998, 44(5): 780-788. PMID: 9818934. DOI: 10.1002/ana.410440512.
15 靳梅, 刘静, 耿文锦, 等. 脑干听觉诱发电位联合闪光视觉诱发电位对高危儿发育性协调障碍的诊断价值[J]. 中华物理医学与康复杂志, 2020, 42(11): 1026-1028. DOI: 10.3760/cma.j.issn.0254-1424.2020.11.017.
16 孙瑞迪, 崔琳, 李承, 等. 儿童脱髓鞘型和轴突型吉兰-巴雷综合征临床、神经电生理特征和预后[J]. 临床儿科杂志, 2018, 36(6): 428-431. DOI: 10.3969/j.issn.1000-3606.2018.06.007.
17 毛梅, 郑艳, 姚源蓉. 吉兰-巴雷综合征小纤维损伤的研究进展[J]. 中华神经医学杂志, 2020, 19(6): 623-626. DOI: 10.3760/cma.j.cn115354-20190723-00423.
18 Taly AB, Arunodaya GR, Rao S. Sympathetic skin response in Guillain-Barré syndrome[J]. Clin Auton Res, 1995, 5(4): 215-219. PMID: 8520217. DOI: 10.1007/BF01824010.
19 吴钢, 潘丽雅. 交感皮肤反应检查对吉兰-巴雷综合征自主神经损害的诊断价值[J]. 重庆医学, 2011, 40(5): 519-520. DOI: 10.3969/j.issn.1671-8348.2011.05.052.
20 于晓莉, 张艳芬, 张玉琴, 等. 交感神经皮肤反应在糖尿病患儿周围神经病早期诊断中的应用[J]. 实用儿科临床杂志, 2012, 27(8): 622-624. DOI: 10.3969/j.issn.1003-515X.2012.08.023.
21 Meh D, Denislic M. Subclinical neuropathy in type I diabetic children[J]. Electroencephalogr Clin Neurophysiol, 1998, 109(3): 274-280. PMID: 9741795. DOI: 10.1016/s0924-980x(98)00017-4.
22 Cariga P, Catley M, Mathias CJ, et al. Characteristics of habituation of the sympathetic skin response to repeated electrical stimuli in man[J]. Clin Neurophysiol, 2001, 112(10): 1875-1880. PMID: 11595146. DOI: 10.1016/s1388-2457(01)00647-2.
23 Haapaniemi TH, Korpelainen JT, Tolonen U, et al. Suppressed sympathetic skin response in Parkinson disease[J]. Clin Auton Res, 2000, 10(6): 337-342. PMID: 11324989. DOI: 10.1007/BF02322257.
24 van den Berg B, Bunschoten C, van Doorn PA, et al. Mortality in Guillain-Barre syndrome[J]. Neurology, 2013, 80(18): 1650-1654. PMID: 23576619. DOI: 10.1212/WNL.0b013e3182904fcc.
25 中华医学会神经病学分会, 中华医学会神经病学分会周围神经病协作组, 中华医学会神经病学分会肌电图与临床神经电生理学组, 等. 中国吉兰-巴雷综合征诊治指南2019[J]. 中华神经科杂志, 2019, 52 (11): 877-882. DOI: 10.3760/cma.j.issn.1006-7876.2019.11.002.
26 Dimario FJ, Edwards C. Autonomic dysfunction in childhood Guillain-Barré syndrome[J]. J Child Neurol, 2012, 27(5): 581-586. PMID: 22241710. DOI: 10.1177/0883073811420872.
27 Shahani BT, Halperin JJ, Boulu P, et al. Sympathetic skin response: a method of assessing unmyelinated axon dysfunction in peripheral neuropathies[J]. J Neurol Neurosurg Psychiatry, 1984, 47(5): 536-542. PMID: 6330307. PMCID: PMC1027833. DOI: 10.1136/jnnp.47.5.536.