ギラン・バレー症候群と自律神経障害

Autonomic Dysfunction in Guillain-Barré Syndrome

ギラン・バレー症候群では，交感神経過活動症状を主とする自律神経障害が高頻度かつさまざまな程度でみられ，これは時に生命予後に関連する。自律神経障害は，免疫攻撃による自律神経線維の伝導障害に起因すると考えられる。この伝導障害が自律神経線維，運動神経および感覚神経に共通する抗原に対する免疫反応によるものなのか，運動・感覚神経への免疫攻撃と同時に起きた特異的な自律神経抗原に対する免疫反応によるものなのかはわかっていない。

Abstract

Guillain-Barré syndrome is an acute-onset, immune-mediated neuropathy characterized by humoral immune attacks on peripheral motor and sensory nerve fibers, with predominant motor involvement. Autonomic dysfunction, typically characterized by sympathetic hyperactivity, is common and varies in severity, occasionally affecting prognosis. This autonomic dysfunction is considered to result from conduction failure in autonomic nerve fibers, similar to the damage observed in motor and sensory fibers. It remains unclear whether this process results from an immune response against common antigens expressed on motor, sensory, and autonomic nerves or from an immune reaction against antigens specific to the autonomic nervous system that occurs concurrently with attacks on motor and sensory nerves. This paper summarizes the clinical semiology and pathological and physiological findings of autonomic dysfunction in Guillain-Barré syndrome and discusses its pathophysiology by comparing it with other immune-mediated autonomic neuropathies.