50例非酮症高血糖性癫痫的临床分析

发布时间：2018-09-06 12:29

【摘要】：目的分析非酮症高血糖性癫痫患者的性别、发病年龄、发病的诱因、发作分型、血糖及糖化血红蛋白水平，头部CT或MRI影像特点，脑电图的特点以及治疗转归等，提高对非酮症高血糖性癫痫的认识和诊治水平。方法回顾分析吉林大学第一医院神经内科收治的50例临床确诊为非酮症高血糖(NKH)性癫痫患者的临床资料，归纳总结患者的性别、发病年龄、发病的诱因、发作分型、血糖及糖化血红蛋白水平，头部CT或MRI影像特点，脑电图的特点以及治疗转归等。结果本研究患者选自神经内科住院患者,年龄最小19岁，最大为77岁，年龄在20岁（含20岁）以下者1例，占2.00%；20到40岁之间（含40岁）者9例，占18.00%；40到60岁之间（含60岁）者20例，占40.00%，平均53.91岁，男性35例，女性15例，男:女=2.33：1，50例患者中癫痫起病前大多数有明确的诱因，其中有7例患者首次发现血糖升高，占14%，43例患者既往糖尿病病史，且43例患者起病前多数合并有明确诱因，未规律应用胰岛素9例，占18%，不合理饮食4例占8%，感染、外伤、妊娠、剧烈运动15例，占30%，其中饮酒5例，占10%，还有不明原因10例，占20%。结合该50例患者的癫痫发作形式，按国际癫痫发作分类（1981），进一步将其分为ⅠA组（简单部分性发作）11例，Ⅰ B组（复杂部分性发作）22例，Ⅰ C组(部分发作继发全面发作)17例，对3组患者的空腹血糖最大值、最小值、平均值、三餐后2小时血糖最大值、最小值、平均值、糖化血红蛋白最大值、最小值、平均值，入院时急检血糖最大值、最小值、平均值分别进行统计分析，观察各组发作类型与血糖水平，糖化血红蛋白的均值是否相关，将IA组与IB组各项检验结果的均值进行分析，早餐后2小时血糖、晚餐后2小时血糖、糖化血红蛋白、入院急检血糖P值均小于0.05，有统计学意义。进一步将IA组与IC组各项检验结果的均值进行分析，发现各项结果P值均小于0.05，均有统计学意义。将IB组与IC组各项检验结果的均值进行分析，只有糖化血红蛋白P值小于0.05，有统计学意义。50例患者在就诊前以及住院过程中均有癫痫发作，Ⅰ A组11例患者表现为部分性发作,其中5例发作形式与文献报道一致，出现特征性的“防御性抽搐”，表现为：偏侧上肢或下肢强直，另外6例表现为局限性的面肌和口角抽动、偏侧肢体抽动。IB组22例患者表现为复杂部分性发作，其中18例患者发作前有心前区不适、恐慌感，另外4例发作前没有明显先兆，22例患者发作进一步发展均出现意识障碍，合并运动停止、凝视或者合并一侧肢体的强直抖动。IC组17例患者中7例为简单部分性发作演变为复杂部分性发作，再演变全身性发作，另外10例直接由简单部分性发作演变为全身性发作。同时发现该50例患者头部CT中43例患者未见明显异常，7例单侧基底节区片状或条形稍高或高密度，边界不清，CT值为30～50HU；行头部MRI检查结果显示40例患者表现无异常，10例T1WI呈高信号， T2WI呈低信号。对50例患者脑电图分析，IA组有8例患者脑电图存在发作间期异常，表现为弥漫性慢波增多，合并少量额-颞区夹杂尖波和棘波发放，其余3例为边缘脑电图。IB组有20例患者脑电图发作间期额区、颞区或枕区见较多中高幅欠规则尖波活动、尖慢波，12例临床发作时见到典型发作期异常脑电图，均为部分性发作脑电特点。IC组12例患者脑电图发作间期出现同上异常，提示部分性发作脑电特点，10例出现典型发作期异常脑电图，突然而广泛的异常放电提示部分继发全面发作。50例患者在住院期间治疗原则是积极降低血糖,并注意纠正电解质紊乱，所有患者住院期间发作次数均较少或者停止发作，其中有7例患者住院期间在降低血糖的同时给予口服奥卡西平150mg2次/日或者托吡酯25mg1次/日，应用1周后停药，在血糖控制良好的情况下停用抗癫痫药物也未再发作。随访成功有17例患者，其中8例患者控制血糖良好，出院后未再出癫痫样发作，其余9例患者仍因血糖控制不佳，有间断发作。结论 NKH性癫痫患者发生于各年龄段,以中老年男性合并糖尿病患者多见，诱因主要是不规律应用降糖药物、感染、剧烈运动等导致的血糖升高。NKH性癫痫临床表现及脑电特点多为部分性发作特点，并且病情严重程度与血糖高低及长期控制水平有关。NKH性癫痫通过纠正高血糖和补液等对症支持治疗可使病情迅速得到改善，，多数不需要系统抗癫痫药物治疗，但如果伴有癫痫持续状态应在调节血糖的基础上短时间应用抗癫痫药物效果更好。大多数NKH性癫痫患者影像学检查无异常，少数患者可以基底节区发现异常病变，CT表现为片状或条形稍高或高密度，边界不清，CT值为30～50HU，头MRI T1WI呈高信号， T2WI呈低信号，上述影像学改变随着血糖的控制是可逆的。
[Abstract]:objective
To analyze the sex, age, predisposing factors, seizure types, blood glucose and glycosylated hemoglobin levels, head CT or MRI features, EEG characteristics and treatment outcome of non-ketotic hyperglycemic epilepsy, so as to improve the understanding and diagnosis of non-ketotic hyperglycemic epilepsy.
Method
The clinical data of 50 patients with non-ketotic hyperglycemia (NKH) epilepsy admitted to the Department of Neurology of the First Hospital of Jilin University were retrospectively analyzed. The sex, age, predisposition, seizure type, blood glucose and glycosylated hemoglobin levels, head CT or MRI imaging characteristics, EEG characteristics and treatment outcome were summarized. Wait.
Result
In this study, patients were selected from neurology department. The youngest was 19 years old, the oldest was 77 years old, 1 case was under 20 years old, accounting for 2.00%; 9 cases were between 20 and 40 years old (including 40 years old), accounting for 18.00%; 20 cases were between 40 and 60 years old (including 60 years old), accounting for 40.00%, with an average age of 53.91 years, 35 males, 15 females, male: female = 2.33:1, 50 patients with epilepsy. Most of the patients had definite predisposing factors before the onset of the disease, of which 7 cases were found to have elevated blood glucose for the first time (14%), 43 cases had a history of diabetes mellitus, and most of the 43 cases had definite predisposing factors before the onset of the disease. 9 cases (18%) had irregular insulin use, 4 cases (8%) had unreasonable diet, 15 cases (30%) had infection, trauma, pregnancy, and strenuous exercise. Among them, 5 cases (10%) had According to the international classification of epileptic seizures (1981), the 50 patients were further divided into group I A (simple partial seizures), group I B (complex partial seizures), group I C (partial seizures followed by comprehensive seizures) and group I C (partial seizures followed by partial seizures) with a maximum, minimum and flat fasting blood glucose level. Mean, 2 hours after three meals, blood glucose maximum, minimum, average, glycosylated hemoglobin maximum, minimum, average, acute blood glucose at admission maximum, minimum, the average value of statistical analysis, observation of each group and blood glucose level, glycosylated hemoglobin mean correlation, IA and IB group of the test results Mean analysis showed that blood glucose 2 hours after breakfast, blood glucose 2 hours after dinner, glycosylated hemoglobin, and blood glucose P value at admission were all less than 0.05, which had statistical significance. Mean analysis showed that only glycosylated hemoglobin P value was less than 0.05, with statistical significance. 50 patients had epileptic seizures before treatment and during hospitalization. 11 patients in group I A showed partial seizures. Five of them had the same seizure pattern as reported in the literature. They had characteristic "defensive convulsions" characterized by hemiplegic upper limbs or lower limbs. In the IB group, 22 patients presented with complex partial seizures, of which 18 had precordial discomfort and panic before the attack, the other 4 had no obvious precursor before the attack, and 22 patients had consciousness disorders, combined with motor arrest and coagulation. Seven of the 17 patients in the IC group developed from simple partial seizures to complex partial seizures, and then to generalized seizures. The other 10 patients developed from simple partial seizures to generalized seizures directly. Head MRI showed no abnormality in 40 patients, high signal on T1WI and low signal on T2WI. Analysis of electroencephalogram (EEG) of 50 patients showed that 8 patients in IA group had abnormality of interval, with diffuse slow wave increase and a small amount of frontotemporal wave. In the IB group, 20 patients showed irregular spike and spike activity in the frontal, temporal and occipital regions, and 12 patients showed typical episodic abnormal electroencephalograms, all of which were characteristic of partial seizures. The same abnormality occurred during the period of hospitalization, suggesting partial seizures of EEG characteristics, 10 cases of typical seizures of abnormal EEG, sudden and extensive abnormal discharge suggesting partial secondary overall seizures. Seven patients were given oral oxcarbazepine 150 mg twice a day or topiramate 25 mg once a day during hospitalization. The seizures were stopped after one week and the antiepileptic drugs were stopped under good blood glucose control. No epileptic seizures occurred again, and the remaining 9 patients were still suffering from intermittent seizures due to poor glucose control.
conclusion
NKH epilepsy occurs in all age groups, mostly in middle-aged and elderly men with diabetes mellitus. The predisposing factors are irregular use of hypoglycemic drugs, infection, vigorous exercise and so on. The clinical manifestations and EEG characteristics of NKH epilepsy are mostly partial seizures, and the severity of the disease is related to the level of blood sugar and long-term control of water. NKH epilepsy can be rapidly improved by correcting hyperglycemia and rehydration. Most patients do not need systemic antiepileptic drugs. However, antiepileptic drugs should be used for a short time on the basis of regulating blood glucose in patients with status epilepticus. Abnormal lesions can be found in the basal ganglia in a few patients. The CT findings are slightly high or high density in strip or strip shape. The boundary is unclear. The CT value is 30-50HU. The MRI of the head is high signal on T1WI and low signal on T2WI.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.1

【参考文献】