癫痫猝死相关危险因素的Meta分析

发布时间：2018-09-19 08:02

【摘要】：研究目的:癫痫猝死是癫痫患者死亡的重要原因。近年来,随着国内外有关癫痫猝死的现况调查、病例对照研究及队列研究的深入,我们对癫痫猝死发病机制、危险因素的认识逐步提高。但由于各个学者在研究设计、样本大小、统计方法等方面的不同,研究结果也不完全一致,甚至相反,需要对所有研究结果进行客观定量的综合,得出较明确的结果。该论文通过对癫痫猝死相关危险因素进行Meta分析,明确其危险因素,为癫痫猝死的预防提供理论依据,进而降低癫痫猝死的发生率。研究方法:将“癫痫猝死”、“危险因素”、“病例对照研究”、“队列研究”四个关键词结合,以“主题词和关键词”的方式检索1997年1月至2017年1月的世界医学文献数据库、MEDLINE、考克兰图书馆、谷歌、中国生物医学文献数据库、相关期刊论文、中文科技期刊全文数据库、万方数据知识服务平台并结合手工查阅的方式。制定文献的纳入和排除标准,然后按此标准由两名评价员分别从检索出的文献中筛选符合要求的文献,若出现分歧,需进行讨论或由第三方仲裁。然后用NOS量表对纳入的文献进行质量评估。从符合文献纳入标准及质量要求的文献中提取Meta分析所需的数据信息,包括基本情况、研究特征、研究结果等。最后利用系统评价数据库软件(Review Manager5.3)进行Meta分析,计算相对危险度(OR值)和95%置信区间(95%CI),并行Z检验。本研究认为P0.05具有统计学意义。研究结果:按照上述检索策略并经过严格筛选,本研究最终共纳入文献8篇,全部为英文文献,总样本量为956例(均为因各种原因死亡的癫痫患者),按照死亡原因是否为癫痫猝死,分为2组,即癫痫猝死组(SUDEP组)325例,非癫痫猝死组(non-SUDEP组)631例为对照组。选取性别、癫痫发病年龄、发作类型、发作频率、抗癫痫药物(AEDs)剂量、多药联合治疗、卡马西平单药治疗、既往心脏病病史、既往精神障碍性疾病、智力障碍、酒精滥用11个危险因素作为此次Meta分析的危险因素。结果显示:癫痫发病年龄≤15岁组SUDEP发生率是发病年龄15岁组SUDEP发生率的4.72倍,差异具有统计学意义(P0.00001)。全面强直-阵挛性发作组SUDEP发生率是非全面强直-阵挛性发作组SUDEP发生率的1.97倍,差异具有统计学意义(P=0.002)。癫痫发作频率≥50次/年组SUDEP发生率是发作频率50次/年组发生率的3.62倍,差异具有统计学意义(P=0.001)。多药联合治疗组SUDEP发生率是单药治疗组的2.36倍,差异具有统计学意义(P0.00001)。男性组SUDEP发生率与女性组SUDEP发生率很相近,差异无统计学意义(P=0.36)。非治疗剂量AEDs组SUDEP发生率与治疗剂量AEDs组SUDEP发生率很相近,差异无统计学意义(P=0.67)。卡马西平单药治疗组SUDEP发生率与其他AEDs治疗组SUDEP发生率很相近,差异无统计学意义(P=0.98)。既往心脏病病史组SUDEP发生率与既往无心脏病病史组SUDEP发生率很相近,差异无统计学意义(P=0.17)。既往精神障碍性疾病组SUDEP发生率与既往无精神障碍性疾病组SUDEP发生率很相近,差异无统计学意义(P=0.28)。智力障碍组SUDEP发生率是无智力障碍组SUDEP发生率的2.39倍,但差异却无统计学意义(P=0.26)。酒精滥用组SUDEP发生率与无酒精滥用组SUDEP发生率很相近,差异无统计学意义(P=0.48)。研究结论:癫痫发病年龄≤15岁、全面强直-阵挛性发作、发作频率≥50次/年、多药联合治疗4个危险因素为癫痫猝死的危险因素;性别、AEDs剂量、卡马西平单药治疗、既往心脏病病史、既往精神障碍性疾病、智力障碍、酒精滥用,现不能确定为癫痫猝死的危险因素。另外本次研究纳入的样本量较小,且未纳入SUDEP的所有危险因素,所得结论仍需进一步证实。
[Abstract]:Research purposes: Sudden death from epilepsy is an important cause of death in epilepsy patients. In recent years, with the in-depth investigation of the status quo of sudden death from epilepsy at home and abroad, case-control study and cohort study, our understanding of the pathogenesis and risk factors of sudden death from epilepsy has gradually improved. In this paper, the risk factors related to sudden death of epilepsy were analyzed by Meta-analysis, and the risk factors were identified, which provided theoretical basis for the prevention of sudden death of epilepsy, and then reduced sudden death of epilepsy. Methods: The world medical literature database, MEDLINE, Cockland Library, Google, China Biomedical Literature Database, was searched by combining the four keywords of "sudden death of epilepsy", "risk factors", "case-control study" and "cohort study" from January 1997 to January 2017. China Journal Full-text Database, Chinese Scientific and Technological Periodicals Full-text Database, Wanfang Data Knowledge Service Platform and the way of manual consulting are used to formulate the criteria for inclusion and exclusion of documents, and then according to the criteria, two evaluators select qualified documents from the retrieved documents respectively. If there are differences, they should be discussed or the third one should be discussed. Then, the quality of the included documents was assessed with NOS scale. The data needed for meta-analysis were extracted from the documents that met the inclusion criteria and quality requirements, including basic information, research characteristics, research results, etc. Finally, the meta-analysis was performed with the system evaluation database software (Review Manager 5.3) to calculate the relative risk. Results: According to the above retrieval strategy and strict screening, 8 articles were included in this study. The total sample size was 956 epileptic patients (all died of various causes) according to the cause of death. For sudden death of epilepsy, there were 325 cases in SUDEP group and 631 cases in non-SUDEP group as control group. The results showed that the incidence of SUDEP was 4.72 times as high as that of 15-year-old group, and the difference was statistically significant (P 0.00001). The incidence of SUDEP in the group with seizure frequency greater than 50 times per year was 3.62 times higher than that in the group with seizure frequency greater than 50 times per year (P = 0.001). The incidence of SUDEP in the multi-drug combination group was 2.36 times higher than that in the single-drug treatment group (P = 0.00001). The incidence of SUDEP in the untreated dose AEDs group was similar to that in the treated dose AEDs group, but the difference was not statistically significant (P = 0.67). The incidence of SUDEP in the carbamazepine monotherapy group was similar to that in the other AEDs groups. The incidence of SUDEP in patients with previous heart disease was similar to that in patients without previous heart disease (P = 0.17). The incidence of SUDEP in patients with previous mental disorders was similar to that in patients without previous mental disorders (P = 0.28). The incidence of SUDEP in the alcohol abuse group was similar to that in the non-alcohol abuse group, but there was no significant difference (P = 0.26). The incidence of SUDEP in the alcohol abuse group was not significantly different from that in the non-alcohol abuse group (P = 0.48). Conclusion: The onset age of epilepsy was less than 15 years old, with generalized tonic-clonic seizures, and the frequency of seizures was more than 50. Sex, AEDs dosage, carbamazepine monotherapy, past heart disease history, past mental disorders, mental disorders, alcohol abuse were not identified as risk factors for sudden death of epilepsy. All the risk factors need further confirmation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1

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