神经超声联合神经磁共振成像在吉兰-巴雷综合征诊断中的意义及机制研究

时鹏; 武心语; 怀玉水; 宋宏伟; 年娣

doi:10.16766/j.cnki.issn.1674-4152.004118

神经超声联合神经磁共振成像在吉兰-巴雷综合征诊断中的意义及机制研究

doi: 10.16766/j.cnki.issn.1674-4152.004118

1.
蚌埠医科大学第一附属医院神经内科，安徽蚌埠 233004
2.
蚌埠医科大学第一附属医院超声科
3.
蚌埠医科大学第一附属医院影像科
4.
蚌埠医科大学检验医学院，安徽蚌埠 233030

基金项目:

安徽省教育厅青年骨干教师境内访学研修项目 JNFX2024039

安徽省临床医学研究转化专项 202304295107020075

详细信息

通讯作者:
年娣，E-mail：niandi07@sohu.com

中图分类号: R745.43
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出版历程
- 收稿日期: 2025-05-14
- 网络出版日期: 2025-10-31

Significance and mechanism of neuroultrasound combined with neuromagnetic resonance imaging in the diagnosis and treatment of Guillain-Barré syndrome

1.
Department of Neurology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨神经超声联合神经磁共振成像在吉兰-巴雷综合征(GBS)患者诊断中的作用及机制。方法选取蚌埠医科大学第一附属医院2021年10月—2025年2月被诊断为GBS的患者43例，另选取24例健康体检者作为对照组。依据临床症状、体征及神经电生理检查将患者分为急性炎性脱髓鞘性多发神经根神经病(AIDP)和急性运动轴突性神经病(AMAN)两个亚型组，采用神经超声测量颈神经根、肢体周围神经横断面积(CSA)；神经磁共振成像测量颈神经根、腰骶神经根CSA；吉兰-巴雷综合征残疾评分量表(GDSS)评估GBS患者神经功能缺失程度，分析CSA与神经缺损程度之间的相关性；收集外周静脉血，ELISA试剂盒测定外周血中细胞焦亡炎性因子水平。结果与对照组相比，AIDP组和AMAN组神经根、肢体周围神经增粗，CSA升高，其中神经超声示3组C₅、C₆比较差异均有统计学意义(H=20.216，P < 0.001；H=12.452，P=0.002)；磁共振成像结果显示，与AMAN组和健康对照组相比, AIDP组患者C₄~C₈、L₃~S₁的CSA显著升高，差异均有统计学意义(P < 0.01)；周围神经CSA与神经功能缺损程度呈正相关关系(P < 0.05)；GBS患者外周血焦亡炎性因子水平较对照组升高，差异有统计学意义(P < 0.05)。结论 GBS患者神经根和周围神经CSA值升高和神经功能缺损可能与焦亡途径激活导致的炎症级联反应有关，联合神经影像学和炎性因子检测有助于GBS的早期诊断，为GBS诊疗提供新思路。
- 吉兰-巴雷综合征 /
- 神经超声 /
- 神经磁共振 /
- 细胞焦亡
Abstract: Objective To explore the significance and mechanism of neuroultrasound and neuromagnetic resonance imaging in the diagnosis of Guillain-Barré syndrome (GBS). Methods A total of 43 GBS patients who were first diagnosed at the First Affiliated Hospital of Bengbu Medical University from October 2021 to February 2025 were enrolled, and 24 patients with normal physical examination were enrolled as control group. Based on neurophysiological examinations, the GBS were classified into two subtypes: acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). Neuroultrasound and neuromagnetic resonance imaging were performed on all subjects. The cross-sectional area of the cervical nerve roots and peripheral nerves (CSA) was measured by neuroultrasound, and the CSA of the cervical nerve root and lumbar sacral nerve root was measured by neuromagnetic resonance imaging. The degree of neurological impairment in GBS was assessed using the GBS disability scale scores (GDSS), and the correlation between CSA values and the degree of neurological deficit was evaluated. Peripheral venous blood was collected, and the levels of pyroptosis-related inflammatory factors in peripheral blood were measured using ELISA. Results Compared with the control group, the nerve roots and peripheral nerves of the limbs in the AIDP group and the AMAN group were thickened, and the CSA value was increased. Among them, nerve ultrasound showed that there were statistically significant differences in C₅ and C₆ among the three groups (H=20.216, P < 0.001; H=12.452, P=0.002), and the magnetic resonance imaging results showed that compared with the AMAN group and the healthy control group, the CSA values of C₄-C₈ and L₃-S₁ in the AIDP group were significantly increased, and the differences were statistically significant (P < 0.01). The CSA value of peripheral nerves was positively correlated with the degree of neurological deficit (P < 0.05). Pyroptotic inflammatory factors were higher than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion The elevated CSA values of nerve roots and peripheral nerves, as well as neurological deficits in GBS, may be associated with the inflammatory cascade triggered by pyroptosis pathway activation. The detection of peripheral blood inflammatory cytokines combined with neuroimaging may facilitate early diagnosis of GBS and provide novel insights for its clinical management.
- Guillain-Barré syndrome /
- Neuroultrasound /
- Neuromagnetic resonance imaging /
- Pyroptosis

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图 1 AIDP组与对照组的神经超声表现

注：A为AIDP组C₅；B为对照组C₅；C为AIDP组C₆；D为对照组C₆。

Figure 1. Neuroultrasound manifestations of the AIDP group and the control group

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图 2 AIDP组与健康对照组的神经磁共振表现

注：A为AIDP组颈神经丛；B为对照组颈神经丛；C为AIDP组腰骶神经丛；D为对照组腰骶神经丛；E为AIDP组颈神经丛；F为AIDP组颈神经丛横断面；G为AIDP组腰骶神经丛；H为AIDP组腰骶神经丛横断面。

Figure 2. The neuromagnetic resonance imaging manifestations of the AIDP group and the healthy control group

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表 1 GBS组与对照组一般资料比较

Table 1. Comparison of general data between the GBS group and the control group

组别	例数	性别 (男性/女性，例)	年龄 (x±s，岁)	身高 (x±s，cm)	体重 (x±s，kg)	饮酒史 [例(%)]	吸烟史 [例(%)]	糖尿病史 [例(%)]
GBS组	43	23/20	61.75±2.58	165.21±4.58	65.16±8.26	3(6.98)	4(9.30)	3(6.98)
对照组	24	15/9	57.19±2.40	165.56±7.08	65.19±12.15	2(8.33)	3(12.50)	1(4.17)
统计量		0.510^a	0.628^b	2.730^b	2.557^b	0.041^a	0.168^a	0.217^a
P值		0.475	0.228	0.828	0.983	0.839	0.682	0.642
注：^a为χ²值，^b为t值。

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表 2 GBS组与对照组超声成像下周围神经CSA比较[M(P₂₅, P₇₅)，mm²]

Table 2. Comparison of peripheral nerve CSA in ultrasound imaging between the GBS group and the control group [M(P₂₅, P₇₅), mm²]

组别	例数	C₅	C₆	C₇	UR	RR
AIDP组	30	11.0(8.0，13.0)^ab	15.0(13.0，19.0)^ab	17.0(14.5，22.5)^ab	9.5(7.0，14.3)^ab	6.5(5.0，9.0)^ab
AMAN组	13	8.0(6.0，10.5)	12.0(10.0，16.5)	15.0(12.5，18.0)	9.0(5.0，11.0)	5.0(4.0，7.0)
对照组	24	6.5(6.0，8.0)	11.0(10.0，14.5)	13.5(11.0，16.0)	7.5(6.0，9.0)	4.0(4.0，5.8)
H值		20.216	12.452	9.558	7.424	9.538
P值		<0.001	0.002	0.008	0.024	0.008

组别	例数	MR	FR	PR	TR
AIDP组	30	13.0(10.0，16.3)^ab	64.0(49.8，84.8)	11.0(9.0，19.5)	31.0(25.0，44.8)
AMAN组	13	8.0(7.0，10.5)	60.0(50.5，72.0)	10.0(7.5，13.5)	29.0(22.5，40.5)
对照组	24	8.0(9.0，10.0)	63.0(48.3，73.0)	9.0(7.3，12.0)	25.0(21.0，32.8)
H值		17.593	0.945	3.595	4.935
P值		<0.001	0.624	0.166	0.085
注：与对照组比较，^aP < 0.05；与AMAN组比较，^bP < 0.05。

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表 3 GBS组与对照组在磁共振成像下不同部位周围神经CSA比较[M(P₂₅, P₇₅)，cm²]

Table 3. Comparison of peripheral nerve CSA in different sites between the GBS group and the control group under magnetic resonance imaging [M(P₂₅, P₇₅), mm²]

组别	例数	C₄	C₅	C₆	C₇	C₈
AIDP组	14	0.54(0.46，0.63)^ab	0.79(0.60，0.98)^ab	0.72(0.63，1.23)^ab	0.60(0.54，0.83)^ab	0.52(0.40，0.60)^ab
AMAN组	7	0.43(0.38，0.50)	0.65(0.38，0.92)	0.69(0.53，0.76)	0.72(0.53，0.87)	0.60(0.46，0.68)
对照组	14	0.42(0.30，0.51)	0.38(0.24，0.51)	0.36(0.33，0.38)	0.31(0.28，0.32)	0.27(0.27，0.28)
H值		10.714	17.369	19.462	17.229	16.925
P值		0.005	<0.001	<0.001	<0.001	<0.001

组别	例数	L₃	L₄	L₅	S₁
AIDP组	14	0.65(0.52，1.53)^ab	0.54(0.44，0.68)^ab	0.85(0.53，1.18)^ab	0.39(0.34，0.54)^ab
AMAN组	7	0.50(0.47，0.58)	0.59(0.48，0.68)	0.48(0.38，0.59)	0.41(0.36，0.50)
对照组	14	0.43(0.33，0.47)	0.36(0.28，0.40)	0.31(0.28，0.83)	0.27(0.24，0.32)
H值		9.128	15.700	3.595	12.104
P值		0.010	<0.001	<0.001	0.002
注：与对照组比较，^aP < 0.01；与AMAN组比较，^bP < 0.01。

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表 4 GBS组与健康对照组外周血炎症因子水平比较(x ±s)

Table 4. Comparison of peripheral blood inflammatory factor levels between the GBS group and the healthy control group

组别	例数	Caspase-1 (ng/mL)	NLRP3 (ng/mL)	IL-18 (pg/mL)	IL-1β (pg/mL)
GBS组	19	2.11±0.44	2.17±0.12	149.58±8.45	43.69±3.85
对照组	19	1.83±0.35	1.79±0.07	125.59±7.23	35.29±0.83
t值		1.130	2.702	2.157	2.133
P值		0.031	0.011	0.038	0.046

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表 5 GBS患者神经超声CSA与GDSS评分的相关性分析

Table 5. Correlation analysis of neuroultrasound CSA and GDSS scores in GBS patients

神经	GDSS评分
神经	r_s值	P值
C₅	0.299	0.052
C₆	0.321	0.036
C₇	0.458	0.002
UR	0.222	0.152
RR	0.231	0.137
MR	0.265	0.086

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表 6 GBS患者磁共振周围神经CSA与GDSS评分的相关性分析

Table 6. Correlation analysis of magnetic resonance peripheral nerve CSA and GDSS scores in GBS patients

神经	GDSS评分
神经	r_s值	P值
C₄	0.337	0.125
C₅	0.459	0.032
C₆	0.623	0.002
C₇	0.452	0.035
C₈	0.565	0.006
L₃	0.282	0.203
L₄	0.235	0.293
L₅	0.276	0.214
S₁	0.049	0.829

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