Objective: To explore the classification, clinical features, the short-term efficacy of intravenous immunoglobulin (IVIg) for Guillain-Barré syndrome(GBS) and look for predictors of acute motor axonal neuropathy (AMAN) during pregnancy. Methods: The clinical data of 45 hospitalized pregnant patients with GBS recruited from October 2008 to October 2017 at the Tianjin Medical University general hospital, Handan City First Hospital and Nankai University Affiliated Tianjin Fourth Central Hospital, were collected and analyzed retrospectively, and patients were divided into the acute inflammatory demyelinating polyneuropathies (AIDP) group and the AMAN group. The clinical features and efficacy of IVIg were compared between the two groups. Logistic regression analysis was used to analyze the predictors of AMAN. Results: There were 25 cases in the AIDP group and 20 cases in the AMAN group. AIDP usually started with distal limb weakness (P=0.001), and AMAN often started with limb weakness (P=0.001) and mostly accompanied by dyspnea (P=0.042). AIDP was often associated with paresthesia (P=0.001) and autonomic dysfunction (P=0.007). The response days of active treatment in the AIDP group and the AMAN group were (1.6±0.5)d and (2.3±0.8)d (P=0.022), the improvement days were (3.6±0.8)d and (5.9±1.0)d (P=0.000), the basic cure days were (7.7±1.3)d and (9.0±0.8)d (P=0.002), the cure days were (12.3±1.1)d and (12.8±0.9)d (P=0.148). Multivariate Logistic regression analysis revealed that preceding diarrhea (OR=13.750; 95% CI 1.386-136.387), limb weakness(OR=12.000;95% CI 2.359-61.048) and limb weakness with dyspnea (OR=10.000; 95% CI 1.048-95.457) were significantly associated with the AMAN-type GBS. Conclusions: AIDP and AMAN are the main types of pregnancy complicating GBS. Most patients present with a single and benign course of disease. IVIg is generally safe and effective. Preceding diarrhea, limb weakness and limb weakness with dyspnea are the predictors of AMAN-type pregnancy complicating GBS.
目的： 探讨妊娠合并吉兰-巴雷综合征（GBS）的临床分型和首发症状，静脉注射免疫球蛋白（IVIg）的短期疗效并寻找急性运动轴索性神经病（AMAN）型GBS的预测因子。 方法： 回顾性分析天津医科大学总医院、邯郸市第一医院和南开大学附属第四中心医院2008年10月至2017年10月收治的45例妊娠合并GBS的临床资料。依据GBS亚型将患者分为急性炎性脱髓鞘性多发神经根神经病（AIDP）组和AMAN组。对比分析两组的首发症状和IVIg的短期疗效。应用Logistic回归模型寻找AMAN型GBS的预测因子。 结果： AIDP组25例，AMAN组20例。AIDP常以双下肢远端无力起病（P=0.001），AMAN常以四肢无力起病（P=0.001）且可伴有呼吸困难（P=0.042）。AIDP较AMAN常伴有感觉异常（P=0.001）和自主神经功能障碍（P=0.007）。AIDP组和AMAN组的治疗显效时间分别为（1.6±0.5）d和（2.3±0.8）d（P=0.022），好转时间分别为（3.6±0.8）d和（5.9±1.0）d（P=0.000），基本治愈时间分别为（7.7±1.3）d和（9.0±0.8）d（P=0.002），治愈时间分别为（12.3±1.1）d和（12.8±0.9）d（P=0.148）。病前腹泻（OR=13.750；95% CI 1.386~136.387）、四肢同时无力起病（OR=12.000；95% CI 2.359~61.048）及肢体无力伴呼吸困难（OR=10.000；95% CI 1.048~95.457）是AMAN型GBS的预测因子。 结论： AIDP和AMAN是妊娠合并GBS的主要发病形式，多为单一、良性病程。IVIg总体安全、有效。病前腹泻、四肢同时无力起病及肢体无力伴呼吸困难是妊娠合并AMAN型GBS的预测因子。.
Keywords: Classification; Guillain-barre syndrome; Immunoglobulins, intravenous; Pregnancy.