以吞咽困难起病的可疑吉兰–巴雷综合征1例
A Case of Suspected Guillain-Barré Syndrome Starting with Dysphagia

本文报道一例75岁，老年男性，前驱呼吸道感染后出现不明原因吞咽困难，结合查体、脑脊液检查、肌电图后拟诊为吉兰–巴雷综合征(Guillain-Barré syndrome, GBS)，予以血浆置换后出现严重过敏反应，患者相关症状未见明显改善。该病例为脑神经受损起病的不典型病例，自身免疫性周围神经病诊断明确，但患者无肌无力表现，予以血浆置换后出现严重过敏反应且疗效欠佳，仍需进一步鉴别诊断。而免疫性周围神经病变治疗方案多为血浆置换和静脉注射免疫球蛋白等传统免疫治疗，特异性差，需要更具有特异性的新兴免疫疗法来优化疗效，改善预后。
This paper reports the case of a 75-year-old man with unexplained dysphagia after antecedent respiratory tract infection, which was proposed to be diagnosed as Guillain-Barré syndrome (GBS) after combining physical examination, cerebrospinal fluid examination, and electromyography, and a severe anaphylactic reaction occurred after plasma exchange, and the patient’s related symptoms did not show significant improvement. This is an atypical case with brain nerve damage, and the diagnosis of autoimmune peripheral neuropathy is clear, but the patient did not have muscle weakness, and suffered a severe allergic reaction after plasma exchange with poor efficacy, so further differential diagnosis is still needed. The treatment options for autoimmune peripheral neuropathy are mostly traditional immunotherapy such as plasma exchange and intravenous immunoglobulin, which have poor specificity, and newer immunotherapies with more specificity are needed to optimize the efficacy and improve the prognosis.