继发性癫痫患者发生心律失常的危险因素及可能机制  

Analysis on the risk factors and possible pathogenesis of arrhythmia in patients with secondary epilepsy

作　　者：张帆 程呈 石茂静[1,2] 徐雪 宋焕秋[1,2] 刘元生 ZHANG Fan;CHENG Cheng;SHI Mao-jing;XU Xue;SONG Huan-qiu;LIU Yuan-sheng(Emergency Department,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院,北京100044 [2]北京积水潭医院

出　　处：《中国心脏起搏与心电生理杂志》2018年第6期558-561,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的分析继发性癫痫患者的心律失常类型、危险因素及可能机制。方法入选北京大学人民医院2004年1月至2014年1月期间住院的所有明确诊断癫痫的2750例病例,筛选出病例资料齐全的继发性癫痫患者569例,按是否发生心律失常将患者分为非心律失常组(A组,366例)和心律失常组(B组,203例)两组,登记患者的一般临床资料、癫痫发作类型、心电图表现、超声心动图改变及实验室检查结果,进行相关性分析。结果与A组比较,B组的高龄(≥65岁)、高血压患者明显增加。B组中,窦性心动过速最常见26.9%(60/223),其次为窦性心动过缓18.8%(42/223)、心房颤动9.9%(22/223)和QTc间期延长2.7%(6/223)。脑部病变发生心律失常以皮质区最多见96例,其次基底节区(74例)及大脑半卵圆中心(65例)。B组患者的年龄、心率、血肌酐及血糖较A组偏高,而血钙、白蛋白偏低(P均<0.05)。Logstic二元回归统计显示,高龄和高血压可能是癫痫发生心律失常的独立危险因素。结论继发性癫痫患者高龄和高血压与癫痫发生心律失常显著相关。脑部病变发生心律失常最常见于皮质区,其次为基底节及大脑半卵圆中心。心律失常常见窦性心动过速、窦性心动过缓、心房颤动及QTc间期延长。Objective To investigate the electrocardiogram features and arrhythmia types,and the risk factors and the possible mechanism of arrhythmia in patients with secondary epilepsy. Methods 2750 cases of the hospitalized epileptic patients were reviewed from Jan 2004 to Jan 2014 in Peking University People’s Hospital.We collected the clinical complete data of 569 patients with secondary epilepsy.They were divided into non-arrhythmia group (366 cases) and arrhythmia group (203 cases).Then we recorded arrhythmia type,age,sex,epileptic seizure type,echocardiographic changes.Comparative analyses between two groups were performed using SPSS 19.0. Results The levels of age,heart rate,QRS duration,serum creatintine,blood glucose in arrhythmia group were higher than that in non-arrhythmia group,and the albumin and blood calcium were lower.Elderly patients (≥65) and high blood pressure were the independent risk factors.The most common arrhythmia was sinus tachycardia (26.9%)(60/223),and then sinus bradycardia (18.8%)(42/223) and atrial fibrillation (AF,9.9%)(22/223).In addition,there were 6 cases of QTc prolongation (2.7%).Cerebral lesions located in cortex (frontal lobe,temporal lobe,parietal lobe,occipital lobe)(96 cases),following by basal ganglia (74 cases) and centrum semiovale (65 cases). Conclusion Elderly age and hypertention may be the independent risk factors for seizures occurred arrhythmia.Pathological position was mostly in cortex,following by basal ganglia and centrum semiovale.Among the arrhythmias,sinus tachycardia was the most common arrhythmia in the secondary epilepsy patients with arrhythmia,and then sinus bradycardia,AF and QTc prolongation.

关 键 词：心血管病学 继发性癫痫 心律失常 危险因素 癫痫性猝死 

分 类 号：R541.7[医药卫生—心血管疾病] R742.1[医药卫生—内科学]