西藏高原地区多药物联合治疗癫痫患者的临床特征分析  

The clinical characteristics of epilepsy patients treated with multi-drug combination therapy in Tibet plateau area

作　　者：连雨晴 普布 陈玉秀 王文轻 郝渝[2] 次央[2] 赵伟伟 赵玉华[2] LIAN Yuqing;PU Bu;CHEN Yuxiu;WANG Wenqing;HAO Yu;CI Yang;ZHAO Weiwei;ZHAO Yuhua(College of Medicine,Tibet University,Lhasa 850000,China;Department of Neurology,People's Hospital of Tibet Autonomous Region,Lhasa 850000,China;Department of Surgery,Central Hospital of Gamba County,Xigaze 857000,China)

机构地区：[1]西藏大学医学院,拉萨850000 [2]西藏自治区人民医院神经内科,拉萨850000 [3]西藏岗巴县中心医院外科,日喀则857000

出　　处：《癫痫杂志》2024年第6期503-507,共5页Journal of Epilepsy

基　　金：西藏自治区科技计划项目重点研发计划(XZ202001Zy0009G);西藏自治区自然科学基金(XZ2022ZR-ZY14Z)。

摘　　要：目的 初步探讨西藏高原地区联合使用≥2种抗癫痫发作药物患者的临床特征。方法 选取2018年9月-2023年9月在西藏自治区人民医院住院治疗且联合使用≥2种抗癫痫发作药物的癫痫患者,收集其性别、年龄、民族等人口学资料及诊断信息、服用药物等临床资料,分析相关人口学特征及临床特征;后期以电话随访的方式记录服药及癫痫发作控制等情况。结果 癫痫患者共计2 295例,符合入选标准的142例(6.2%),其中133例(93.7%)为藏族,男性多于女性(86 vs. 56,P<0.05),未成年及青年患者人数多于中老年(106 vs. 36,P<0.05)。87.3%的患者接受了磁共振成像或计算机断层扫描检查,71.1%的患者异常。癫痫的主要病因为结构性病因(84/142,59.2%)。2种药物联合使用最多(127/142,89.4%),丙戊酸钠与左乙拉西坦联合使用占比最大(46/142,32.4%),规范多药联合治疗后癫痫平均发作频率较基线明显降低,差异具有统计学意义(P<0.05)。在≥14岁的98例患者中,药物难治性癫痫15例(15.3%)、规范联合用药已控制发作18例(18.4%)、联合用药减为单药已控制发作16例(16.3%)、控制良好已停药5例(5.1%)、用药依从性差导致癫痫频繁发作3例(3.1%)、不规范用药15例(15.3%)、死亡17例(17.3%)、失联9例(9.2%)。结论 多药联合治疗及药物难治性癫痫比例均低于既往研究结论,且多药联用抗癫痫发作效果肯定。结构性病因(脑卒中等)为引起癫痫的主要病因,脑部寄生虫感染为高原癫痫的特有因素,加强药物规范使用有助于改善患者治疗现状及预后。Objective e To explore the clinical characteristics of patients with combined use of≥2 kinds of anti-seizure medications in Tibetan plateau.Methods sEpilepsy patients who were hospitalized in the People's Hospital of Tibet Autonomous Region from September 2018 to September 2023 and used≥2 kinds of anti-seizure medications in combination were selected.Their demographic data such as gender,age,and ethnicity,as well as diagnostic information,medication and other clinical data were collected,and relevant demographic and clinical characteristics were analyzed.In the later stage,telephone follow-up was used to record medication and epileptic seizure control.ResultsA total of 2295 patients with epilepsy were included,of which 142(6.2%)met the inclusion criteria,of which 133(93.7%)were Tibetans.There were more males than females(86 vs.56,P<0.05),and more minors and young patients than middle-aged and elderly patients(106 vs.36,P<0.05).87.3%of the patients underwent magnetic resonance imaging(MRI)or computed tomography(CT),and 71.1%of the patients were abnormal.The main cause of epilepsy was structural etiology(84/142,59.2%).The most common combination was two drugs(127/142,89.4%).The largest proportion of combination was sodium valproate and levetiracetam(46/142,32.4%).After standardized multi-drug combination therapy,the average frequency of epilepsy seizures was significantly reduced compared with the baseline,and the difference was statistically significant(P<0.05).Among the 98 patients aged≥14 years,15 cases(15.3%)had drug-refractory epilepsy,18 cases(18.4%)had seizures controlled by standardized combination medication,16 cases(16.3%)had seizures controlled by reducing combination medication to a single drug,5 cases(5.1%)had good control and had stopped medication,3 cases(3.1%)had frequent epileptic seizures due to poor medication compliance,15 cases(15.3%)had irregular medication,17 cases(17.3%)died,and 9 cases(9.2%)were lost.Conclusion The proportion of epilepsy treated with multiple drugs and refractory to d

关 键 词：高原 癫痫 抗癫痫发作药物 病因 药物难治性癫痫 

分 类 号：R742.1[医药卫生—神经病学与精神病学]