急性缺血性卒中血管内治疗术后癫痫发生率以及危险因素的研究  

Study on the incidence and risk factors of post-stroke epilepsy after endovascular treatment for acute ischemic stroke

作　　者：吴健隆 王罗俊 王萱 李德帅 师瑞 李扬 魏东 江文 WU Jianlong;WANG Luojun;WANG Xuan;LI Deshuai;SHI Rui;LI Yang;WEI Dong;JIANG Wen(Department of Neurology,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院神经内科,陕西西安710032

出　　处：《空军军医大学学报》2024年第12期1435-1440,共6页Journal of Air Force Medical University

基　　金：国家重点研发计划项目(2021YFC2401201-01)。

摘　　要：目的 探索急性缺血性卒中(AIS)血管内治疗术后卒中后癫痫(PSE)的发生率及其相关危险因素。方法 回顾性分析2019年1月至2023年12月于空军军医大学西京医院神经内科接受血管内治疗的AIS患者的临床资料,根据是否出现PSE,将患者分为PSE组和非PSE组。对两组进行人口学特征、TOAST分型、卒中程度、颅内病灶特点、血管内治疗情况、并发症和预后的比较,同时运用多因素Cox回归分析评估PSE的危险因素。结果 共对197例AIS血管内治疗术后患者进行分析,随访中位时间为16(12,24)个月;16例(8.1%)患者出现PSE,首次迟发性发作的中位时间为卒中后8(6,12)个月。PSE组在房颤病史、病灶累及部位(额叶、颞叶、岛叶),皮层受累及术后出血转化方面的占比均高于非PSE组(P<0.05)。PSE组患者良好预后(mRS≤2分)比例较低(37.5%vs 67.4%,P=0.016)。多因素Cox回归分析显示梗死体积超过大血管供血区域的2/3(P=0.013)和早发性发作(P<0.001)是血管内治疗术后PSE的独立危险因素。结论 对于接受血管内治疗的AIS患者,特别是大面积梗死和出现早发性发作的患者,应高度警惕PSE的发生。PSE的出现通常与较差的神经功能预后相关。Objective To investigate the incidence and associated risk factors of post-stroke epilepsy(PSE)following endovascular treatments for acute ischemic stroke(AIS).Methods This retrospective study enrolled patients with AIS who underwent endovascular treatments at the Department of Neurology,Xijing Hospital,Air Force Medical University from January 2019 to December 2023.Patients were divided into PSE group and non-PSE group based on the occurrence of PSE.Demographic characteristics,TOAST classification,stroke severity,intracranial lesion characteristics,details of endovascular treatments,complications,and prognosis were compared between the two groups.Multivariate Cox regression analysis was used to evaluate the risk factors of PSE.Results A total of 197 patients with AIS who underwent endovascular treatments were analyzed,with a median follow-up time of 16(12,24)months.PSE occurred in 16 patients(8.1%),with a median time to the first late seizure of 8(6,12)months after stroke.The proportions of PSE group in the history of atrial fibrillation,lesion involvement in the frontal,temporal,and insular lobes,cortical involvement,and postoperative hemorrhagic transformation were higher than those of non-PSE group(P<0.05).The proportion of patients with a good prognosis(mRS≤2)was lower in the PSE group(37.5%vs 67.4%,P=0.016).Multivariate Cox regression analysis identified infarct volume exceeding 2/3 of the blood supply area of large vessels(P=0.013)and early seizures(P<0.001)as independent risk factors for PSE after endovascular treatments.Conclusion For patients with AIS receiving endovascular treatments,especially those with larger infarct volume and early seizures,the occurrence of PSE should be highly vigilant.The occurrence of PSE is often associated with poor neurological outcomes.

关 键 词：急性缺血性卒中 血管内治疗 癫痫 卒中后癫痫 预后 危险因素 

分 类 号：R741[医药卫生—神经病学与精神病学]