成人惊厥性癫痫持续状态病因分析  

Aetiology of convulsive status epilepticus in adults

作　　者：张杰[1,2] 郭永华 周东 洪桢[1] ZHANG Jie;GUO Yonghua;ZHOU Dong;HONG Zhen(Department of Neurology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Neurology,First People's Hospital of Longquanyi District,Chengdu,Sichuan 610100,P.R.China;Department of Neurology,the People's Hospital of Leshan,Leshan,Sichuan 614000,P.R.China)

机构地区：[1]四川大学华西医院神经内科,成都610041 [2]成都市龙泉驿区第一人民医院神经内科,成都610100 [3]乐山市人民医院神经内科,四川乐山614000

出　　处：《华西医学》2019年第4期400-404,共5页West China Medical Journal

基　　金：国家自然科学基金(81671291)

摘　　要：目的探讨惊厥性癫痫持续状态(convulsive status epilepticus,CSE)患者的病因。方法以"癫痫""痫性发作""癫痫持续状态""癫痫发作"为关键词,借助电子病历检索系统,回顾性采集成都市龙泉驿区第一人民医院和乐山市人民医院2012年1月—2017年12月住院的癫痫患者病历资料。由经过培训的癫痫专科医生按照纳入标准及排除标准严格筛选出CSE患者,根据其病史资料、辅助检查,分析CSE的病因及CSE病因在年龄、性别、文化水平、居住地、有无癫痫病史中的差异,并采用logistic回归分析癫痫预后相关因素。结果共检索出癫痫住院患者852例,其中CSE患者104例,年龄18～86岁,男75例,女29例;CSE死亡人数13例(12.5%)。CSE的病因在有无癫痫病史、不同年龄阶段中差异有统计学意义(χ2=52.396、18.354,P<0.05),不同性别、文化水平、居住地的患者CSE病因的差异无统计学意义(P>0.05)。在既往有癫痫病史的患者中,停药或减少抗癫痫药物是CSE的主要原因[28例(57.1%)];在无癫痫病史的患者中,脑血管疾病[19例(34.5%)]是CSE的最常见原因。CSE在65岁及以上人群中主要病因为脑血管疾病[17例(43.6%)],而在65岁以下人群中主要病因为停药及减少抗癫痫药物[20例(30.8%)]。多因素logistic回归分析癫痫预后相关因素显示,癫痫发作持续时间对患者预后情况产生影响[比值比=1.299,95%置信区间(1.074,1.571),P=0.007],其余各因素并未对癫痫预后有影响(P>0.05)。结论脑血管病是老年CSE患者的首位病因。癫痫患者不规律服药是CSE的突出和可避免的诱因。Objective To investigate the etiology of patients with convulsive status epilepticus(CSE).Methods By taking epilepsy,seizure,status epilepticus,and epileptic seizure as keywords,the clinical data of epilepsy patients hospitalized in the First People’s Hospital of Longquanyi District of Chengdu and the People’s Hospital of Leshan from January,2012 to December,2017 were retrospectively collected from a retrieval system for electronic patient records.The collected CSE cases were screened by trained epilepsy specialists in strict accordance with inclusion criteria and exclusion criteria.The etiology of CSE,and the pathogenetic distinctions among patients with different ages,sexes,educational levels,places of residence,and histories of epilepsy were analyzed based on medical histories and accessory examinations.The prognostic factors for epilepsy were determined using logistic regression analysis.Results In this study,a total of 852 hospitalized epilepsy cases were retrieved,among which 104 cases were CSE cases aged between 18 and 86,including 75 males and 29 females.There were 13 CSE deaths(12.5%).There were significant differences in the pathogeneses among CSE patients with different ages and histories of epilepsy(χ2=52.396,18.354;P<0.05).However,no significant difference in CSE pathogeneses was observed among patients with different sexes,educational levels,or places of residence(P>0.05).Drug withdrawal or dose reduction was the leading cause of CSE in patients with a history of epilepsy(n=28,57.1%),while cerebrovascular diseases(n=19,34.5%)were common causes among those without a history.Among patients aged over 65,cerebrovascular diseases(n=17,43.6%)were determined as the major causes of CSE,while for those aged under 65,drug withdrawal or dose reduction was the main pathogeny(n=20,30.8%).Results obtained from multivariate logistic regression analysis on the prognostic factors for epilepsy showed that the duration of epileptic seizure significantly influenced the prognosis of patients[odds ratio=1.299,95%con

关 键 词：病因 癫痫 癫痫持续状态 

分 类 号：R742.1[医药卫生—神经病学与精神病学]