儿童创伤性癫痫进展为药物难治性癫痫的危险因素分析  

Analysis of risk factors for the progression of post-traumatic epilepsy in children to drug-resistant epilepsy

作　　者：曹西 霍坤良 陈靓 李佳宇 杨子茵 高安亮 Cao Xi;Huo Kunliang;Chen Liang;Li Jiayu;Yang Ziyin;Gao Anliang(Department of Neurosurgery,the Second Affiliated Hospital of Chengdu Medical College,China National Nuclear Corporation 416 Hospital,Chengdu 610000,China)

机构地区：[1]成都医学院第二附属医院·核工业四一六医院神经外科,成都610000

出　　处：《中华神经外科杂志》2024年第9期897-901,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨儿童创伤性癫痫(PTE)从早期药物可控进展为药物难治性癫痫(DRE)的相关危险因素。方法回顾性分析2013年1月至2023年6月于成都医学院第二附属医院·核工业四一六医院神经外科就诊的232例PTE患儿的临床资料,年龄均≤14岁,随访时间均>2年。其中54例为DRE组,178例为非DRE组。比较两组临床资料的差异,筛选影响PTE进展为DRE的相关因素;将两组差异有统计学意义的指标纳入多因素logistic回归模型中进行分析,筛选影响儿童PTE进展为DRE的独立危险因素。结果与非DRE组比较,DRE组受伤年龄≤7岁、颅脑损伤部位为颞叶、脑挫裂伤、伤后24 h内未手术、脑电图显示癫痫波及服药依从性差的患儿占比高,差异均有统计学意义(均P<0.05);而两组患儿的性别、受伤原因、是否为开放性颅脑损伤、入院时格拉斯哥昏迷评分的差异均无统计学意义(均P>0.05)。多因素logistic回归分析显示,年龄≤7岁(OR=7.27,95%CI:2.59~20.40)、颅脑损伤部位为颞叶(OR=13.06,95%CI:3.41~49.97)、脑挫裂伤(OR=5.36,95%CI:1.18~24.41)与PTE进展为DRE相关(均P<0.05)。结论受伤年龄≤7岁、颞叶受损、脑挫裂伤是PTE患儿进展为DRE的独立危险因素。Objective To investigate the risk factors for post-traumatic epilepsy(PTE)progressing from early drug-controlled status to drug-resistant epilepsy(DRE)in children.Methods A retrospective analysis was performed on the clinical data of 232 pediatric patients with post-traumatic epilepsy who were admitted to Department of Neurosurgery,the Second Affiliated Hospital of Chengdu Medical College,China National Nuclear Corporation 416 Hospital from January 2013 to June 2023.All patients were≤14 years old,and the follow-up time was>2 years.Among them,54 cases were in the DRE group and 178 cases were in the non-DRE group.The differences in clinical data between the two groups were compared to screen for factors that influence the progression of PTE to DRE.The statistically significant differences between the two groups were included in the multivariate logistic regression model for analysis,and the independent risk factors that influenced the progression of PTE to DRE in children were screened.Results Compared with the non-DRE group,the DRE group had a higher proportion of children who were≤7 years old,whose brain injury site was the temporal lobe,brain contusion and laceration,who did not undergo surgery within 24 hours after the injury,whose electroencephalogram showed epileptic discharges,and who had poor medication compliance(all P<0.05).However,there were no statistically significant differences in the gender,cause of injury,open craniocerebral injury,or Glasgow Coma Score on admission between the two groups of children(all P>0.05).Multivariate logistic regression analysis showed that age≤7 years old(OR=7.27,95%CI:2.59-20.40),brain injury site in the temporal lobe(OR=13.06,95%CI:3.41-49.97),brain contusion(OR=5.36,95%CI:1.18-24.41)were associated with the progression of PTE to DRE(all P<0.05).Conclusion Age≤7 years old,temporal lobe damage,and brain contusion are independent risk factors for children with PTE to progress to DRE.

关 键 词：颅脑损伤 癫痫 创伤后 儿童 危险因素 药物难治性癫痫 

分 类 号：R726.5[医药卫生—儿科]