神经外科门诊癫痫患者临床特征及其发作控制的影响因素分析  

Clinical features of patients with epilepsy in Neurosurgery Outpatient and influencing factors for their seizure control

作　　者：李信晓 丁江伟 霍显浩 蒋战胜 武跃辉[1] 李培栋[1] 王磊[4] 吴宁波 王新军 孙涛[3] Li Xinxiao;Ding Jiangwei;Huo Xianhao;Jiang Zhansheng;Wu Yuehui;Li Peidong;Wang Lei;Wu Ningbo;Wang Xinjun;Sun Tao(Department of Neurosurgery,Fifth Affiliated Hospital of Zhengzhou University,Systematic Epilepsy Treatment Center of He'nan Province,Zhengzhou 450052,China;Department of Neurosurgery,Frist Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Neurosurgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Neurosurgery,He'nan Provincial People's Hospital,Zhengzhou 450003,China;Department of Neurosurgery,Zhoukou Central Hospital,Zhoukou 466099,China;Department of Neurosurgery,Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第五附属医院神经外科,河南省癫痫病系统化诊疗中心,郑州450052 [2]郑州大学第一附属医院神经外科,郑州450052 [3]宁夏医科大学总医院神经外科,银川750004 [4]河南省人民医院神经外科,郑州450003 [5]周口市中心医院神经外科,周口466099 [6]郑州大学第三附属医院神经外科,郑州450052

出　　处：《中华神经医学杂志》2023年第9期910-917,共8页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金面上项目(81971085);中国抗癫痫协会癫痫科研基金—UCB基金(CU-2022-002)。

摘　　要：目的探讨神经外科门诊癫痫患者的临床特征及其发作控制的影响因素。方法选择自2017年9月至2022年12月于郑州大学第五附属医院等6家三级甲等医院神经外科门诊就诊且符合研究条件的673例癫痫患者为研究对象,应用河南省癫痫病系统化诊疗中心自行编制的调查问卷收集患者就诊时的临床资料(包括一般人口学资料、受教育程度、发病初始年龄、发作周期、发作持续时间、病程、家庭年收入及发作控制情况等),总结其临床特征,并应用单因素分析及多因素Logistic回归分析筛选影响门诊癫痫患者发作控制情况的相关因素。结果(1)673例神经外科门诊癫痫患者中,发病初始年龄<1岁(婴儿期)、1~2岁(幼儿期)、3~5岁(学龄前期)、6~16岁(少年期)、17~39岁(青年期)、40~64岁(中年期)及≥65岁(老年期)者分别为50例(7.4%)、78例(11.6%)、192例(28.5%)、100例(14.9%)、68例(10.1%)、72例(10.7%)及113例(16.8%);既往治疗情况中,未干预、药物治疗和手术治疗者分别占23.0%(155/673)、72.4%(487/673)和4.6%(31/673);癫痫发作控制良好、不良者分别占55.9%(376/673)和44.1%(297/673)。(2)受教育程度为中等教育(OR=2.199,95%CI:1.037~15.221,P=0.033)和初等教育及以下(OR=3.544,95%CI:2.101~21.343,P=0.012)、癫痫每天发作(OR=4.788,95%CI:1.369~33.103,P=0.011)、每次发作持续≥3 min(OR=4.179,95%CI:3.338~18.550,P=0.003)、病程为1~3年(OR=0.379,95%CI:0.108~0.882,P=0.031)和≥3年(OR=0.199,95%CI:0.077~0.602,P=0.001)、目前服用的抗癫痫药物数量≥3种(OR=6.237,95%CI:2.195~17.837,P=0.001)是门诊癫痫患者发作控制不良的独立危险因素。结论神经外科门诊癫痫患者中,儿童期前起病占比最大,药物治疗仍是主要的治疗方式;患者受教育程度低、发作周期短、发作持续时间长、病程长及服用药物数量多预示其抗癫痫治疗效果会较差。Objective To investigate the clinical features of patients with epilepsy in Neurosurgery Outpatient and influencing factors for their seizure control.Methods Six hundred and seventy-three epilepsy patients admitted to Neurosurgery Outpatient of 6 hospitals including Fifth Affiliated Hospital of Zhengzhou University from September 2017 to December 2022 were chosen.Clinical data(including general demographic data,education level,onset age,onset cycle and duration,course of onset,family annual income and seizure control)were collected using a questionnaire prepared by He'nan Epilepsy Systematic Diagnosis and Treatment Center to summarize the clinical features.Univariate and multivariate Logistic regressions were used to analyze the influencing factors for their seizure control.Results(1)In these 673 epilepsy patients,50(7.4%),78(11.6%),192(28.5%),100(14.9%),68(10.1%),72(10.7%)and 113(16.8%),respectively,were<1 year old(infant stage),1-2 years old(children stage),3-5 years old(preschool stage),6-16 years old(juvenile stage),17-39 years old(young stage),40-64 years old(middle-aged stage)and≥65 years old(elderly stage).In the past medical treatment history,23.0%(155/673)patients did not receive intervention,72.4%(487/673)received medication,and 4.6%(31/673)received surgical treatment;55.9%(376/673)had good seizure control and 44.1%(297/673)had poor seizure control.(2)Secondary education(OR=2.199,95%CI:1.037-15.221,P=0.033),primary education or below(OR=3.544,95%CI:2.101-21.343,P=0.012),daily seizures(OR=4.788,95%CI:1.369-33.103,P=0.011),each seizure lasted≥3 min(OR=4.179,95%CI:3.338-18.550,P=0.003),course of disease≥3 years(OR=0.199,95%CI:0.077-0.602,P=0.001),course of disease for 1-3 years(OR=0.379,95%CI:0.108-0.882,P=0.031),and currently taken antiepileptic drugs for 3 or more(OR=6.237,95%CI:2.195-17.837,P=0.001)were independent risk factors for poor seizure control in epilepsy patients.Conclusion In Neurosurgery Outpatient,children with diseases before childhood enjoy the largest proportion;drug therapy remain

关 键 词：癫痫 神经外科门诊患者 临床特征 发作控制 

分 类 号：R651[医药卫生—外科学]