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目的 探讨以小纤维感觉神经受累为主的格林 巴利综合征患者的临床特点和治疗方法。方法 回顾性分析 4例以麻木疼痛为主诉的格林 巴利综合征患者的临床资料。 4例均进行相应的电生理测试和相关实验室检查。结果 4例均有病前感染史 ,麻木起病 ,5～ 14d内病情达高峰 ;脑脊液分析示蛋白细胞分离。脑脊液 2 4hIgG增高 3例 ,寡克隆区带 (OB)阳性 2例。常规感觉神经传导速度 (SCV)正常 ,运动神经传导速度 (MCV)和 (或 )末端潜伏期 (ML)减慢 3例 ,正常 1例 ,正中神经F波传导速度减慢 3例 ,胫后神经F波潜伏期延长 2例 ,4例F波出现率均低于正常 ,针极肌电图 2例正常 ,2例胫前肌大力收缩时为单纯相 ;上下肢交感神经皮肤反应 (SSR)均在正常范围内。预后良好 ,使用丙种球蛋白治疗的患者 ,麻木疼痛感恢复较使用激素治疗者快。随诊 6个月后 ,1例患者仍有麻木感存在。结论 对临床表现为麻木和疼痛的格林 巴利综合征患者 ,在除外交感神经节后纤维受累的情况下 ,应考虑小纤维感觉神经受累。早期丙种球蛋白的使用可能有助于感觉异常的恢复。
Objective To investigate the clinical features and treatment of patients with Guillain-Barre syndrome with small fiber sensory nerve involvement. Methods A retrospective analysis of 4 patients with numbness pain as the chief complaint of Guillain-Barre syndrome in patients with clinical data. 4 cases were the corresponding electrophysiological tests and related laboratory tests. Results All the 4 patients had a history of pre-infection, numbness onset, and peak disease within 5 to 14 days. Cerebrospinal fluid analysis showed that protein cells were separated. Cerebrospinal fluid 24 hIgG increased in 3 cases, oligoclonal band (OB) positive in 2 cases. Normal sensory nerve conduction velocity (SCV) was normal, motor nerve conduction velocity (MCV) and / or terminal latency (ML) slowed down in 3 cases, normal in 1 case, median nerve F wave slowed down in 3 cases, posterior tibial nerve F The latency of wave was prolonged in 2 cases, 4 cases of F wave were lower than normal, 2 cases of needle electromyography were normal and 2 cases of severe tibialis anterior muscle contraction was simple phase. The sympathetic skin reaction (SSR) Range. Prognosis is good, the use of gamma globulin in patients with recovery, numb pain recovery faster than those who use hormone therapy. After 6 months of follow-up, one patient still had numbness. Conclusions For patients with Guillain-Barre syndrome who are clinically numb and painful, sensory nerve involvement in the small fibers should be considered in the absence of sympathetic ganglion fibers. The use of early gamma globulin may help sensory recovery.