单药阶梯式加量治疗新诊断成人癫痫的长期结局分析  

The long-term outcomes of increasing dosage step by step of monotherapy in newly diagnosed adult epilepsy

作　　者：李竞一 潘松青[1] Li Jingyi;Pan Songqing(Department of Neurology,Renmin Hospital of Wuhan University,Wuhan 430060)

机构地区：[1]武汉大学人民医院神经内科,430060

出　　处：《卒中与神经疾病》2022年第1期58-62,共5页Stroke and Nervous Diseases

摘　　要：目的探讨抗发作药物阶梯式加量治疗新诊断成人癫痫的长期结局及影响长期结局的临床因素。方法收集武汉大学人民医院癫痫库2009年3月1日-2016年12月31日就诊的新诊断成人癫痫患者,回顾性分析不同水平限定日剂量(Defined daily dose, DDD)单药治疗新诊断成人癫痫患者获得3年无发作的可能性,并探讨影响长期结局的临床因素。结果本研究共纳入316例新诊断成人癫痫患者,单药治疗3年无发作152例(48.1%),其中每日剂量≤25%DDD组(A组)9例、25%DDD<每日剂量≤50%DDD组(B组)89例、50%DDD<每日剂量≤75%DDD组(C组)44例、每日剂量>75%DDD组(D组)10例,3年无发作率分别为2.85%(9/316)、35.04%(89/254)、44.90%(44/98)和30.30%(10/33),B组3年无发作率明显高于A组(P=0.000),B组与C组3年无发作率无明显差异(P=0.088),C组与D组3年无发作率也无明显差异(P=0.142)。93.42%(142/152)的患者在75%DDD内获得3年无发作。单因素分析显示合并多种发作类型比只有一种发作类型3年无发作率低[8/44(18.18%)vs.144/272(52.94%),P<0.05]、神经影像学表现[磁共振成像(Magnetic resonance imaging, MRI)/计算机X线断层扫描(Computed tomography, CT)]异常者3年无发作率低于影像学表现正常患者[67/170(39.41%) vs.85/146(58.22%),P<0.05)]。进一步多因素回归分析表明合并多种发作类型(OR=4.779,95%CI=2.471~9.242,P=0.000)以及影像学(MRI/CT)表现异常(OR=2.186,95%CI=1.455~3.283,P=0.000)是不能获得3年无发作的预测因素。结论对于新诊断的成人癫痫,在50%DDD内3年无发作率随剂量的增加而显著提高,绝大多数患者在75%DDD内获得3年无发作;合并多种发作类型以及神经影像学(MRI/CT)表现异常是影响药物治疗长期结局的独立危险因素。Objective To study the long-term outcomes of newly diagnosed adult epilepsy treated with increasing dosage step by step of anti-seizure drugs and the clinical factors affecting the long-term outcomes. Methods The newly diagnosed adult epilepsy patients were enrolled in Renmin Hospital of Wuhan University from March 1, 2009 to December 31, 2016.The possibility of seizure-free for three years for them with different levels of prescribed daily dose with monotherapy was analyzed retrospectively, and the clinical factors affecting the long-term outcomes were discussed. Results A total of 316 newly diagnosed adult epilepsy patients were enrolled in this study, among which 152 cases(48.1%) achieved seizure-free for three years with monotherapy. 9 cases were in the group less than or equal to 25% DDD(group A), 89 cases were in the group more than 25% but not more than 50% DDD(group B), 44 cases were in the group more than 50% but not more than 75% DDD(group C) and 10 cases were in the group more than 75% DDD group(group D). The rates of seizure-free for three years of the four groups were 2.85%(9/316), 35.04%(89/254), 44.90%(44/98) and 30.30%(10/33), respectively. The rate of group B was significantly higher than that of group A(P=0.000), but there was no significant difference between group B and group C(P=0.088), and between group C and group D(P=0.142).93.42%(142/152) of patients achieved seizure-free for three years within 75% DDD.Univariate analysis showed that the three-year seizure-free rates of patients with multiple seizure typeswere lower than that of patients with only one seizure type(8/44,18.18% vs.144/272,52.94%, P<0.05). The three-year seizure-free rate of patients with abnormal neuroimaging findings(MRI/CT) was lower than that of patients with normal imaging findings(67/170,39.41% vs.85/146,58.22%,P<0.05). Further multivariate regression analysis showed that multiple seizure types [odds ratio(OR)=4.779,95% confidence interval(CI)=2.471~9.242,P=0.000], and neuroimaging(MRI/CT) abnormalities(OR=2.186,95%CI=

关 键 词：新诊断成人癫痫 限定日剂量 处方日剂量 长期结局 临床影响因素 

分 类 号：R742.1[医药卫生—神经病学与精神病学]