Yeşim GÜZEY ARAS, Belma DOĞAN GÜNGEN

Guillain-Barré sendromunda mevsimsel özellikler ve klinik alt tiplerin 63 vakalık seride değerlendirilmesi

Amaç: Guillain–Barré sendromu (GBS) akut yada subakut başlayabilen genellikle ilerleyici flask paralizi ile seyreden inflamatuar demyelinizan poliradikülonöropatiler içerisinde yer alan bir hastalıktır. Bu çalışmanın amacı kendi hasta grubumuzda GBS'nin mevsimlere göre dağılımını, mevsimle GBS alt tipleri arasındaki ilişkiyi ve mevsimle prognoz arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntem: Bu çalışmada 2007-2017 yılları arasında kliniğimizde yatarak tedavi görmüş Asbury tanı kriterlerine göre kesin GBS tanısı almış erişkin hastaların dosyaları retrospektif olarak tarandı.Hastaların yaş, cinsiyet, geçirilmiş enfeksiyonlar, mevsimlere göre dağılımı, klinik alt tipleri , hastanede kalış süreleri, Hughes Fonksiyonel Ölçeği Skoru (HFÖS), yoğun bakım ihtiyaçları, entübasyon , mortalite durumları kaydedildi.Bulgular: Çalışmaya 63 hasta alındı. Hastaların 35'i erkek, 28'i kadındı. Yaş ortalaması erkeklerde 51,4±18,2, kadınlarda 47,07±18,9 idi. AIDP hastaların 37 (%58,7)'sinde, AMAN hastaların 8 (%12,7)'inde, AMSAN hastaların 6 (%9,5)'sında, Miller-Fisher Sendromu hastaların 5 (%7,9)'inde görüldü. GBS semptomları başlamadan önceki 2-4 haftada hastaların 30 (%47,6)'unda ÜSYE, 15 (%2,8)'inde GİS enfeksiyonu, 1 (%1,6)'inde aşı öyküsü vardı. Mevsimsel dağılıma bakıldığında hastaların 13(%20,6)'ü kış mevsiminde, 21 (%33,3)'i ilkbaharda, 19 (%30,2)'u yaz mevsiminde, 10 (%15,9)'u sonbaharda idi. Mevsimsel dağılım ile klinik alt tipler arasındaki ilişkiye bakıldığında AIDP formunda mevsimsel fark saptanmazken aksonal formlar ilkbahar ve yaz mevsiminde diğer mevsimlere göre daha sık ortaya çıkmıştır. Hastaneye ilk başvuru HFÖS ile mevsimsel dağılıma bakıldığında en düşük HFÖS ilkbaharda saptandı. Sonuç: Çalışmamızda, GBS hastalarında aksonal form, ilkbahar ve yaz mevsiminde daha sıktı. Buna ek olarak, ilkbaharda görülenler vakalarda prognoz daha iyi iken kış aylarında daha kötüdür. Hastaların mevsimsel dağılımları arasındaki ilişkinin daha fazla sayıda hasta ile değerlendirilmesi gerektiğini düşünüyoruz.

Anahtar Kelimeler:

Mevsim, GBS, prognoz

Seasonal characteristics and clinical treatment in the Guillaine-Barré syndrome 63 evaluation of the patient series

Background: Guillain-Barré syndrome (GBS) is a disease that occurs with in the inflammatory demyelinating polyradiculoneuropathies of the common flaccid paralysis that can begin in the acute or subacute stage. The aim of this study was to investigate the relationship between seasonal distribution of GBS in our own patient group, the relationship between seasonal GBS subtypes and seasonal prognosis.Material and Method: This study retrospectively reviewed the files of adult patients who were diagnosed as GBS-diagnosed according to Asbury diagnostic criteria in our clinic between 2007 and 2017. Age, sex, past infections, seasonal distribution, clinical subtypes, hospitalization times, Hughes Functional Scale HFRS), intensive care needs, intubation, and mortality were recorded.Results: Sixty-three patients were included in the study. The patients were 35 males and 28 females. The mean age was 51.4 ± 18.2 in males and 47.07 ± 18.9 in females. In 37 (58.7%) of AIDP patients, 8 (12.7%) in AMAN patients, 6 (9.5%) in AMSAN patients and 5 (7.9%) in Miller-Fisher syndrome patients were found to be indent. Before the onset of GBS symptoms, there were 30 (47.6%) Upper respiratory tract infection patients, 15 (23.8%) indent GIS infections, and 1 (1.6%) indent vaccination history at 2-4 weeks. When the seasonal distribution was examined, 13 (20.6%) of the patients were in the winter, 21 (33.3%) were in the spring, 19 (30.2%) were in the summer and 10 (15.9%) were in the autumn. Given the relationship between seasonal distribution and clinical subtypes, no seasonal difference was found in AIDP form, where asaxonal forms appeared more frequently in spring and summer than in other seasons. When the first application to the hospital and the seasonal distribution with HFRS were taken, the lowest HFRS was determined in the spring. Conclusion: In our study, axonal form in GBS patients was more frequent in spring and summer seasons. In addition, those who are seen in the spring are better be haved and the treatment is worse in the winter months while the treatment is better. We think that the relationship between seasonal distributions of patients should be evaluated with higher number of studies.

Keywords:

Season, GBS, prognozis,

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