影响中国西部地区新诊断成人癫痫患者预后相关因素分析

发布时间：2018-04-21 21:07

本文选题：癫痫 + 预后　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:探究影响中国西部地区新诊断成人癫痫患者抗癫痫药物治疗预后的相关因素。方法:通过对2014年1月至2015年12月来自四川省人民医院、重庆医科大学大学附属医院及四川大学华西医院三个癫痫中心新诊断的癫痫患者进行连续性登记并随访,详细记录其性别、年龄、居住地、发病年龄、发作类型、病因及目前治疗状况等,进行描述性统计分析。结果:1.该研究共纳入了806例癫痫患者,其中男性477例,女性329例,男女性别比例为1.45:1,各组在男女性别构成比上无差异。2.各组之间居住地对疗效的影响存在统计学差异,居住于城市患者390例,非城市农村患者416例,居住于城市患者预后更好。3.起病年龄16~25岁143例占17.7%,26~40岁164例占20.3%,41~59岁197例占24.4%,≥60岁者302例占37.5%,中国西部地区癫痫的起病年龄以老年组(≥60岁)居多,且预后较差,16~25岁发病的预后较好。4.806例癫痫患者中特发性及隐源性癫痫325例(40.3%),症状性癫痫481例(59.7%),病因排名顺次为脑卒中141例(29.3%)、海马硬化84例(17.5%)、脑外伤66例(13.7%)、颅内炎症60例(12.5%)、皮质发育畸形与其他脑发育不良30例(6.2%)、高热惊厥附加症30例(6.2%)、脑肿瘤术后27例(5.6%)、围生期损伤12例(2.5%)、神经退行性变9例(1.9%)、代谢及中毒性疾病9例(1.9%)、其它病因(包括动静脉畸形、动脉瘤、结节性硬化、系统性红斑狼疮、药源性、电击伤、脑积水等)13例(2.7%);有明确病因的癫痫患者预后较差,经全因素分析病因中海马硬化和代谢及中毒性疾病所致癫痫患者预后更差。男性患者中最常见的病因顺次为脑卒中61例(24.3%)、脑外伤46例(18.3%)、海马硬化43例(17.1%)、颅内炎症33例(13.1%)、高热惊厥附加症21例(8.4%)、皮质发育畸形及其他脑发育不良16例(6.4%)、脑肿瘤术后15例(6.0%)、围生期损伤4例(1.6%)、神经退行性病变3例(1.2%)、代谢性及中毒性疾病2例(0.8%)及其它少见病因7例(2.8%);女性患者中的最常见的病因顺次为脑卒中80例(34.8%)、海马硬化41例(17.8%)、颅内炎症27例(11.7%)、脑外伤20例(8.7%)、皮质发育畸形14例(6.1%)、脑肿瘤12例(5.2%)、高热惊厥附加症9例(3.9%)、围生期损伤8例(3.5%)、代谢性及中毒性疾病7例(3.0%)、神经退行性病变6例(2.6%)、及其他少见病因6例(2.6%)。病因中男性患者脑外伤、高热惊厥高于女性患者,女性患者脑卒中高于男性差异具有统计学意义;其余各病因之间无统计学差异。5.发作类型中局灶性癫痫患者318例占39.5%,全面性发作302例占37.5%,无法分类186例占23.0%,局灶性癫痫比例略高于全面性癫痫发作患者且预后较差。6.药物治疗中单药治疗686例占85.1%,2种及以上药物者120例占14.9%,其中服用2种药物者99例,2种以上药物者21例。单药治疗药物使用顺次为左乙拉西坦227例(33.1%)、丙戊酸180例(26.2%)、奥卡西平136例(19.8%)、拉莫三嗪107例(15.6%)、卡马西平18例(2.6%)、托吡酯13例(1.9%)、加巴喷丁2例(0.3%)苯妥英钠1例(0.1%)、苯巴比妥1例(0.1%)、氯硝西泮1例(0.1%)。统计学分析单药治疗患者疗效较多药治疗好。单药治疗中使用拉莫三嗪患者预后较好,余治疗药物无统计学差异。7.服药过程中患者药物依从性差的100例占12.4%,依从性好的患者706例占87.6%,经统计分析依从性为影响预后的独立危险因素。8.纳入的806例患者脑电图重度异常646例(80.1%),轻度异常160例(19.9%);有家族史患者17例(2.1%),无家族史患者789例(97.9%);夜间发作患者105例(13.0%),非夜间发作患者701例(87.0%);454例(71.7%)有婚姻史,429例(67.8%)有生育史,每天均有发作的210(26.1%)例,每周发作的51(6.3%)例,每月发作的187(23.2%)例,小于每月发作的358(44.4%)例;经统计学分析脑电图、发作频率、家族史、夜间发作、婚育史与预后无统计学差异。9.多因素Logistic回归分析提示非城市偏远地区、起病年龄≥60岁、局灶性癫痫、多药治疗、药物依从性差为预后不良的独立危险因素。结论:1.中国西部地区老年组(起病年龄≥60岁)癫痫患者的预后较差,可能为中国西部地区随着年龄的增加,症状性癫痫所占比例也相应增加,同时西部地区男性使用摩托车等交通工具及多从事建筑行业,容易发生脑外伤事故,导致脑外伤继发癫痫比例较高,此类患者对抗癫痫药物的反应较差有关。2.中国西部地区局灶性癫痫所占的比例较高,可能与西部地区经济情况和地域状况有关,西部地区男性使用摩托车等交通工具及多从事建筑行业,容易发生外伤事故,增加了局灶性癫痫的发生率,且此部分癫痫患者的预后较差。3.中国西部地区新诊断癫痫患者单药治疗比例较高且单药治疗无发作、显效、有效率较高,可能与近年来相关癫痫的继续培训和患者科普教育提高了专科医师的癫痫规范化诊疗水平以及患者的依从性有关。4.癫痫患者对抗癫痫药物治疗的依从性是影响治疗的独立危险因素。中国西部地区近年来患者对诊疗的依从性有所提高,可能与专科培训教育提高了专科医生诊疗水平和患者科普教育提高了患者的依从性有关。5.本研究提示,在中国西部地区,居住于非城市偏远地区、起病年龄≥60岁、局灶性癫痫、多药治疗、药物依从性差为预后不良的独立危险因素。而脑电图、家族史、发作频率虽无统计学差异,尚需进一步扩大样本研究证实。
[Abstract]:Objective: To explore the related factors affecting the prognosis of antiepileptic drugs for newly diagnosed adult epileptic patients in Western China. Methods: the continuity of the newly diagnosed epilepsy patients from January 2014 to December 2015 from Sichuan Provincial People's Hospital, the Affiliated Hospital of Medical University Of Chongqing, and three epileptic centers in the epilepsy center of Sichuan University. The sex, age, residence, age, age, type of attack, etiology and current status of treatment were recorded and analyzed in detail. Results: 1. the study included 806 cases of epileptic patients, including 477 males and 329 females, and the sex ratio of men and women was 1.45:1, and there was no difference in the sex ratio of men and women in each group.2.. There were 390 cases of urban patients, 416 cases in non urban rural areas, 416 cases in non urban rural patients, and better prognosis of patients in urban areas, 143 cases aged 16~25 and 143 cases, 164 cases of 26~40 years old and 24.4%, 302 cases in 41~59 years, 302 cases of 37.5% years, and the onset age of epilepsy in Western China. The elderly group (> 60 years old) was in the majority, and the prognosis was poor. The prognosis of 16~25 years old was better than that of 325 cases of idiopathic and cryptogenic epilepsy (40.3%), 481 cases of symptomatic epilepsy (59.7%), 141 cases of cerebral apoplexy (29.3%), 84 hippocampal sclerosis (17.5%), 66 cases of brain injury (13.7%), intracranial inflammation 60 (12.5%), cortical development malformation. 30 cases (6.2%), 30 cases of hyperthermal convulsion additional syndrome (6.2%), 27 cases (5.6%) after brain tumor operation, 12 cases of perinatal injury (2.5%), 9 neurodegenerative cases (1.9%), 9 (1.9%) metabolic and toxic disease (1.9%), other causes (including arteriovenous malformation, aneurysm, nodular sclerosis, systemic lupus erythematosus, drug origin, electrical injury, hydrocephalus) 13 cases (2.7%); the prognosis of epileptic patients with definite etiology was poor. The prognosis of epilepsy patients caused by CNOOC and metabolic and toxic diseases was worse by all factors analysis. The most common causes in male patients were stroke 61 cases (24.3%), brain trauma 46 cases (18.3%), hippocampus sclerosis (17.1%), intracranial inflammation 33 cases (13.1%), high fever. 21 cases (8.4%), 16 cases of cortical dysplasia and other brain dysplasia, 15 cases (6%), 4 cases of perinatal injury (1.6%), 3 neurodegenerative diseases (1.2%), 2 cases of metabolic and toxic diseases (0.8%) and other rare diseases in 7 cases (2.8%), and the most common causes in female patients were stroke cases. %), 41 cases of hippocampal sclerosis (17.8%), 27 cases of intracranial inflammation (11.7%), 20 cases of brain injury (8.7%), 14 cases of cortical malformation (6.1%), 12 cases of brain tumors (5.2%), 9 cases of hyperthermal convulsion additional syndrome, 8 cases (3.5%), metabolic and toxic diseases, cases of neurodegenerative diseases, and other rare causes. Brain trauma, high fever convulsion was higher than that of female patients, and the difference of stroke in female patients was higher than that of men. There was no statistical difference between the other causes of.5. seizures in 318 cases, 39.5% in focal epilepsy, 37.5% in 302 cases, 23% in 186 cases, and the proportion of focal epilepsy was slightly higher than that in all cases. Patients with sexual seizures and poor prognosis were treated with single drug therapy in 686 cases, 686 cases accounted for 85.1%, and 120 cases of 2 or more drugs accounted for 14.9%, of which 99 were treated with 2 drugs and 21 in 2 or more. The use of single drug treatment was 227 cases (33.1%), valproic acid 180 (26.2%), lamotrigine, and lamotrigine. 7 cases (15.6%), C Masi Bing 18 cases (2.6%), topiramate 13 cases (1.9%), gabapentin 2 cases (0.3%) phenytoin sodium 1 cases (0.1%), phenobarbital 1 cases (0.1%), clonazepam 1 cases (0.1%). Statistical analysis of single drug treatment patients with more effective treatment. Single drug treatment in the use of lamotrigine patients with better prognosis, there is no statistically significant difference in the treatment of.7. clothes. In the drug process, 100 patients with poor compliance were 12.4%, and 706 patients with good compliance accounted for 87.6%. 806 patients with severe abnormal electroencephalogram (80.1%), 160 cases (19.9%) with severe abnormal electroencephalogram (19.9%), 17 cases (2.1%) and no family history patients (97.9%) were included in the statistical analysis of independent risk factor.8.. 105 (13%) patients with nocturnal seizures, 701 non nocturnal patients (87%), 454 (71.7%) history of marriage, 429 (67.8%) having a history of childbirth, 210 (26.1%) cases (26.1%), 51 (6.3%) episodes per week, 187 (23.2%) cases each month, less than monthly episodes, and statistical analysis of electroencephalogram, seizure frequency, family history, night. There was no statistical difference between the history of marriage and marriage and the prognosis of marriage..9. multiple factor Logistic regression analysis suggested that the age of onset was more than 60 years old in non urban areas, focal epilepsy, multidrug therapy, and poor compliance as an independent risk factor for poor prognosis. Conclusion: 1. the prognosis of epileptic patients in the old age group of Western China (the age of onset age 60 years old) is poor, In Western China, the proportion of symptomatic epilepsy is also increased with the increase of age in Western China. At the same time, men in the western region use motorcycles and other transportation tools and are more likely to engage in the construction industry. It is easy to have brain injury accidents, resulting in higher proportion of epilepsy secondary to brain trauma, and the poor response to epilepsy drugs in such patients is related to.2. China. The proportion of focal epilepsy in the western region is high, which may be related to the economic and regional conditions in the western region. The men in the western region use motorcycles and other transportation tools and are more engaged in the construction industry, which are prone to traumatic accidents and increase the incidence of focal epilepsy, and the prognosis of this part of the epileptic patients is.3. in Western China. The rate of single drug treatment in the newly diagnosed epileptic patients is high and the single drug treatment is free from seizures. It is effective and effective. It may be related to the continuing training of epilepsy in recent years and the patient's science education to improve the standardized diagnosis and treatment level of the specialist and the compliance of the patients with.4. epilepsy. The independent risk factors of sound therapy. In recent years, patients in Western China have improved their compliance to diagnosis and treatment. It may improve the level of diagnosis and treatment of specialist doctors and patients' compliance with specialist training education, which is related to the compliance of patients with.5.. 60 years of age, focal epilepsy, multidrug therapy and poor compliance are independent risk factors for poor prognosis. Although electroencephalogram, family history, and frequency of seizures are not statistically different, it is still necessary to further expand the sample study.

【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1

【参考文献】