脑卒中后癫痫发作的预测因素及预后  

Predictive factors and prognosis of post-stroke seizures

作　　者：张静[1,2] 赵建华[2] 刘娜[3] 鲍婕妤[4] Zhang Jing;Zhao Jianhua;Liu Na;Bao Jieyu(Post-Graduate School,Xinxiang Medical University,Xinxiang 453003,China;Department of Neurology,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Neurology,People's Hospital of Henan University,Kaifeng 475001,China;Department of Neurology,People's Hospital of Zhengzhou University,Zhengzhou 450066,China)

机构地区：[1]新乡医学院研究生院,新乡453003 [2]河南省人民医院神经内科,郑州450003 [3]河南大学人民医院神经内科,开封475001 [4]郑州大学人民医院神经内科,郑州450066

出　　处：《中华行为医学与脑科学杂志》2022年第5期414-419,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：河南省医学科技公关计划项目(SBGJ2018075)。

摘　　要：目的评估脑卒中后癫痫发作(post-stroke seizures,PSS)的预测因素和预后。方法回顾性收集了2018年1~12月住院的急性前循环脑梗死患者共315例,包括95例PSS患者,220例未发生PSS的患者,分别作为观察组和对照组。记录患者的性别、年龄、病灶的侧别、影像学特征、既往史以及癫痫发作的时间和类型等临床特征信息。使用Alberta卒中项目早期CT评分(Alberta stroke program early CT score,ASPECTS)评估梗死范围,使用美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)和改良Rankin量表(modified Rankin scale,MRS)评估脑梗死的严重程度和预后,根据欧洲协作性急性卒中研究Ⅲ(European cooperative acute stroke studyⅢ,ECASSⅢ)分类系统将脑梗死的出血转化进行分级。采用SPSS 21.0软件进行统计分析,分类变量使用卡方检验进行组间比较,连续变量使用t检验或非参数检验进行组间比较。结果观察组的ASPECTS评分[5(4,7)分]低于对照组[7(5,8)分],而房颤、出血转化、层状坏死(laminar necrosis,LN)和含铁血黄素沉积的比例(分别占31.6%、45.3%、24.2%、26.3%)均较对照组高(分别占20.9%、28.2%、9.1%、16.4%),均差异有统计学意义(均P<0.05);在多因素分析中,ASPECTS评分(OR=0.658,95%CI=0.556~0.778,P<0.001)、出血转化(OR=2.307,95%CI=1.311~4.059,P=0.004,),以及LN(OR=2.530,95%CI=1.250~5.123,P=0.010)和含铁血黄素沉积(OR=2.308,95%CI=1.201~4.436,P=0.012)是PSS的影响因素。在本组病例中,部分性发作继发全面性发作是最常见的发作类型,占42.1%(40/95),单纯部分性发作和复杂部分性发作均占12.6%(12/95),全面性发作占32.6%(31/95)。两组的平均随访时间分别为24.1个月和24.6个月,观察组出院时和最后一次随访时MRS评分[3(2,4)分,2(1,4)分]均高于对照组[2(1,3)分,1(1,3)分],差异具有统计学意义(均P<0.05)。结论脑梗死后并发PSS可影响患者预后,并且梗死范围大、出血转化,存在LN和�Objective To assess the predictive factors and prognosis of post-stroke seizures.Methods A total of 315 inpatients with acute anterior circulation cerebral infarction from January 2018 to December 2018 were retrospectively collected,including 95 patients with PSS as observation group and 220 patients without PSS as control group.Clinical characteristics of the patients were recorded,including gender,age,lesion specificity,imaging features,past history,and the time and type of seizures.The Alberta stroke program early CT score(ASPECTS)was used to assess the extent of infarction,the national institutes of health stroke scale(NIHSS)and the modified rankin scale(MRS)were used to assess the severity and prognosis of cerebral infarction.The hemorrhage transformation of cerebral infarction was graded according to the European cooperative acute stroke studyⅢ(ECASSⅢ)classification system.SPSS 21.0 software was used for data analysis.Chi-square test was used for categorical variables and t-test or non-parametric test was used for continuous variables.Results The observation group had lower ASPECTS scores compared with the control group(5(4,7),7(5,8)),the presence of atrial fibrillation,hemorrhage transformation,laminar necrosis(LN)and hemosiderin deposition(31.6%,45.3%,24.2%,26.3%)were higher than those of control group(20.9%,28.2%,9.1%,16.4%),and the differences were statistically significant(all P<0.05).In multivariate analysis,ASPECTS score(OR=0.658,95%CI=0.556-0.778,P<0.001),hemorrhage transformation(OR=2.307,95%CI=1.311-4.059,P=0.004),LN(OR=2.530,95%CI=1.250-5.123,P=0.010)and hemosiderin deposition(OR=2.308,95%CI=1.201-4.436,P=0.012)were the influencing factors of PSS.Partial secondary generalized seizures was the most common type of seizures,and in this group it accounted for 42.1%(40/95),simple partial seizures and complex partial seizures accounted for 12.6%(12/95)respectively,and generalized seizures accounted for 32.6%(31/95).The mean follow-up time of the two groups was 24.1 months and 24.6 months,respective

关 键 词：脑卒中后癫痫发作 层状坏死 含铁血黄素沉积 预测因素 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R742.1[医药卫生—临床医学]