2例表现为急性延髓麻痹的儿童吉兰–巴雷综合征变异型及文献复习

Variants of Guillain-Barre Syndrome in Two Children Showing Acute Bulbar Paralysis and Literature Review

摘要: 目的：探讨儿童吉兰–巴雷综合征变异型的临床特点、诊断和治疗。方法：分析青岛大学附属医院儿科2例吉兰–巴雷综合征变异型患儿的临床表现、相关辅助检查结果以及临床治疗效果。结果：临床表现为言语含糊、饮水呛咳、吞咽困难，外周神经病神经节苷脂抗体分别为抗GM1_IgM抗体阳性及抗GM4 IgG抗体阳性，脑脊液检查未见明显蛋白–细胞分离现象。肌电图示神经源性损害。2例均给予静滴免疫球蛋白治疗后症状明显好转。结论：急性延髓麻痹是吉兰–巴雷综合征的少见变异型，极易出现漏诊和误诊，须结合临床表现、脑脊液、电生理和影像学检查及早做出诊断和治疗。

Abstract: Objective: To explore the clinical feature, diagnosis and treatment of the variants of Guillain-Barre syndrome (GBS) in Children. Methods: The clinical manifestations, relevant auxiliary examination results and clinical therapeutic effects of two children with GBS variants from Department of Pediatrics, the Affiliated Hospital of Qingdao University were analyzed. Results: The clinical manifestations included speech disorder, bucking because of drinking water, and difficulty in swallowing. The ganglioside antibodies of peripheral neuropathy were anti-GM1 IgM antibody positive and anti-GM4 IgG antibody positive. Cerebrospinal fluid examination showed that there was no obvious protein-cell isolation. Electromyography indicated that there were neurogenic damages. The symptoms of the two children improved significantly after they were given intravenous drip of immune globulin. Conclusion: Acute bulbar paralysis is a rare variant of GBS, so misdiagnosis and missed diagnosis are very common. Early diagnosis and treatment of acute bulbar paralysis should be done by combining clinical manifestations, cerebrospinal fluid, electrophysiology and imaging examination.