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Neuromuscular
Research paper
Guillain-Barré syndrome in southern China: retrospective analysis of hospitalised patients from 14 provinces in the area south of the Huaihe River
  1. Shuping Liu1,
  2. Zheman Xiao1,
  3. Min Lou2,
  4. Fang Ji3,
  5. Bei Shao4,
  6. Hongyuan Dai5,
  7. Can Luo6,
  8. Bo Hu7,
  9. Ruiling Zhou8,
  10. Zhangyu Zou9,
  11. Jing Li10,
  12. Xiaoyi Li11,
  13. Jun Xu12,
  14. Fan Hu13,
  15. Chao Qin14,
  16. Lian Wang15,
  17. Tao Liu16,
  18. Runtao Bai17,
  19. Yangmei Chen18,
  20. Haiyan Lv19,
  21. Ruxu Zhang20,
  22. Xiaoming Wang21,
  23. Yunfu Wang22,
  24. Shanling Ren23,
  25. Xiaoming He24,
  26. Zhenwei Jiang25,
  27. Huiwen Wu26,
  28. Donghui Yu27,
  29. Wenqiong Yang28,
  30. Wenjing Luo29,
  31. Daokai Gong30,
  32. Bin Chen31,
  33. Yin Liu1,
  34. Jiajia Yao1,
  35. Yujie Yang1,
  36. Jingxia Guan1,
  37. Mingzhen Zhu1,
  38. Xiujuan Fu1,
  39. Genshan Gao1,
  40. Hong Zhang1,
  41. Man Ding1,
  42. Shanghua Fan1,
  43. Qian Cao1,
  44. Jingyi Lu1,
  45. Zuneng Lu1
  1. 1 Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
  2. 2 Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
  3. 3 Department of Neurology, First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
  4. 4 Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
  5. 5 Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
  6. 6 Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  7. 7 Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  8. 8 Department of Neurology, Fujian Provincial Hospital, Fuzhou, China
  9. 9 Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
  10. 10 Department of Neurology, Xiangya Hospital of Central South University, Changsha, China
  11. 11 Department of Neurology, Guizhou Provincial People’s Hospital, Guiyang, China
  12. 12 Department of Neurology, Northern Jiangsu People’s Hospital, Yangzhou, China
  13. 13 Department of Neurology, Jiangxi Provincial People’s Hospital, Nanchang, China
  14. 14 Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
  15. 15 Department of Geriatric Medicine, Kunming General Hospital of PLA, Kunming, China
  16. 16 Department of Neurology, Hainan General Hospital, Haikou, China
  17. 17 Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
  18. 18 Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
  19. 19 Department of Neurology, Shanghai Jiaotong University Affiliated First People’s Hospital, Shanghai, China
  20. 20 Department of Neurology, The Third Xiangya Hospital of Central South University, Changsha, China
  21. 21 Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
  22. 22 Department of Neurology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
  23. 23 Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
  24. 24 Department of Neurology, Xiangyang Central Hospital, Hubei University of Arts and Science, Xiangyang, China
  25. 25 Department of Neurology, The First Affiliated Hospital of Yangtze University, Jingzhou, China
  26. 26 Department of Neurology, The First People’s Hospital Of Yichang, China Three Gorges University, Yichang, China
  27. 27 Department of Neurology, XianNing Central hospital, The First Affiliated Hospital of Hubei University of Science and Technology, XianNing, China
  28. 28 Department of Neurology, Dongfeng General Hospital of Hubei University of Medicine, Shiyan, China
  29. 29 Department of Neurology, Wuhan General Hospital of PLA, Wuhan, China
  30. 30 Department of Neurology, Jingzhou Central Hospital, Tongji Medical College, Huazhong University of Science Technology, Jingzhou, China
  31. 31 Department of Neurology, Jingmen No. 1 People’s Hospital, Jingmen, China
  1. Correspondence to Professor Zuneng Lu, Department of Neurology, Renmin Hospital of Wuhan University, Wuhan 430060, China; lznprof{at}163.com

Abstract

Objectives The clinical and epidemiological profiles of Guillain-Barré syndrome (GBS) in southern China have yet to be fully recognised. We aimed to investigate the subtypes of GBS in southern China, compare the clinical features of demyelinating form with that of axonal form and test whether preceding infections and age have influence on the clinical phenotype, disease course and severity of GBS.

Methods Medical records of patients with a diagnosis of GBS admitted to 31 tertiary hospitals, located in 14 provinces in southern China, from 1 January 2013 to 30 September 2016, were collected and retrospectively reviewed.

Results Finally. 1056 patients, including 887 classic GBS and 169 variants, were enrolled. The 661 classic patients with available electromyographic data were grouped as having acute inflammatory demyelinating polyneuropathy (AIDP, 49.0%), acute motor axonal neuropathy (AMAN, 18.8%), inexcitable (0.9%) and equivocal (31.3%). In contrast to AIDP, patients with AMAN were characterised by earlier nadir (P=0.000), higher Hughes score at nadir (P=0.003) and at discharge (P=0.000). Preceding upper respiratory infections were identified in 369 (34.9%) patients, who were more inclined to develop AIDP (P=0.000) and Miller-Fisher syndrome (P=0.027), whereas gastrointestinal infection were found in 89 (8.4%) patients, who were more prone to develop AMAN (P=0.000), with more severe illness (P=0.001) and longer hospital stay (P=0.009). Children (≤15 years) and the elderly (≥56 years) were more severe at nadir, the elderly had the longest hospital stay (P=0.023).

Conclusion AIDP is the predominant form in southern China, which is different from data of northern China. The different subtypes, preceding infection and age of onset can partially determine the disease progression, severity and short-term recovery speed of GBS.

Clinical trial registration ChiCTR-RRC-17014152.

https://doi.org/10.1136/jnnp-2017-316930

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    Footnotes

    • SL and ZX contributed equally.

    • Contributors ML, FJ, BS, HD, CL, BH, RZ, ZZ, JL, XL, JX, FH, CQ, LW, TL, RB, YC, HL, RZ, XW, YW, SR, XH, ZJ, HW, DY, WY, WL, DG and BC helped us to collect complete medical records and develop the research plan, and finally they involved in the diagnosis and discussion of complex patients. SL, ZX, YL, JY, YY, JG, MZ, XF, GG, HZ, MD, SF, QC, JL and ZL took part in validating the diagnosis and information extraction. SL, YL and JY typed the data in table and verified all the information. SL and ZX wrote the paper.

    • Funding This work was supported by grants from Wuhan Science and Technology Bureau scientific research project (2015060101010047). The sponsors played no role in the study design, data collection and analysis or decision to submit the article for publication.

    • Competing interests None declared.

    • Ethics approval This retrospective study was approved by the ethics committee of the Remin Hospital of Wuhan University, Wuhan, China. The informed consent was waived.

    • Provenance and peer review Not commissioned; externally peer reviewed.