摘要
目的 观察吉兰－巴雷综合征（Ｇｕｉｌｌａｉｎ－Ｂａｒｒ ｓｙｎｄｒｏｍｅ，ＧＢＳ）中枢神经系统病理改变。方法２２例病人，其中全解８例，脑、脊髓、坐骨神经局解１４例。常规取块，光镜观察。结果①３例脑表静脉充盈，脑回变宽，脑沟变窄和轻度杭大孔疝；②大脑神经节细胞多呈缺血性改变，海马锥体细胞轻微脱落，运动神经细胞核染色质溶解。延髓、脑桥有轻微水肿。８例于延髓、脑桥小血管周围有淋巴细胞浸润，２例在脑桥与额叶白质处有灶性脱髓鞘。部分小脑浦肯野细胞脱落，１例于小脑分子层有数处以小胶质细胞为主的小胶质结节；③１６例脊髓前角细胞肿胀，染色质呈中心性溶解，核偏位，以颈、腰段改变最明显。在胞浆内可有空泡形成，伴淋巴细胞浸润；④周围神经：２０例以节段性脱髓鞘和淋巴细胞浸润为主要改变，另有２例轴索改变较重，肿胀断裂，髓球形成等，疑为急性炎性轴索型神经根神经病。结论①脑干和脊髓内的淋巴细胞浸润，可视为周围神经病理改变的继续和扩延；②胶质结节的发现提示病人有嗜神经病毒感染的可能；③大脑、脑干灶性脱髓鞘，表明ＧＢＳ可以合并中枢神经系统脱髓鞘。
Objective To investigate the neuropathological changes of cental nervous system in Guillain-Barre syndrom. Methods Brain, spinal cord and sciatic nerve were obtained from 22 cases of Guillain-Barre syndrome. Eight cases were exam- ined by general autopsy, 14 cases were examined by boied autopsy. HE, KB, Bielschowsky,Weil and Sudan Ⅲ staining were carried out, the sections were observed by light microscopy. Results 1. Cerbral superficial veins congested, widening of the cor- tical sulci, narrowed gyri and and mild cerebellar tonsillar hernia were present. 2. Majority of cerbral neurons presented an ischemic changes. Slightly loss of hippocampal pyramidal neruons were found. There was chromatolysis of motor neurons of brain stem. Lymphocytic infiltration around the small vessels occurred in the pens and medullary oblongata in 8 cases. Focal demyelination was noted in pens and frontal white matter in 2 cases. Loss of Purkinje cells and appearance of glial nodules were observed in molecular layer of cerebllum. 3. Swellin, central chromatolysis and eccentric nuclei of anterior horn cells appeared in 16 cases, which were pronounced in cervical and lumbal segment of spinal cord. Vaculated neuroplasma and lymphacytic infiltrition be seen. 4. Segmental demyelination and lympohocytic infiltration were the main neruopathological changes observed in 20 cases. There were two other cases in which the axon were severely involved, which showed ewelling and breakdown of axons and as well as axonal bulbs. Conclusions 1. Lymphocytic infiltration in brain stem and spinal coal were in continuousness of pathologial changes of peripher- al nerves. 2. Finding of gbal nodules suggested that there are possibility of infection of neurotropic virus. 3. Occurence of focal demyelination in cerebrum and brain stem indicated that Guillain-Barre syndrome may have combined involvement of central and peripheral nervous system.
出处
《中国神经精神疾病杂志》
CAS
CSCD
北大核心
2001年第1期13-15,共3页
Chinese Journal of Nervous and Mental Diseases
