急性缺血性卒中后痫性发作危险因素及临床特点分析

发布时间：2019-01-19 11:25

【摘要】：背景：目前,在我国脑卒中已经超过恶性肿瘤成为第一致死原因。脑卒中包括缺血性卒中和出血性卒中,其中缺血性卒中是最常见的类型。在老年患者,卒中是痫性发作最常见的原因。同时,痫性发作会影响卒中的早期治疗,并进一步恶化卒中患者预后。不论是卒中亦或痫性发作对于患者本人、家庭及社会都是沉重的负担。目前国内外针对缺血性卒中后痫性发作及癫痫的发病率、危险因素及临床特点等进行了一系列的研究,但是由于实验设计、样本量、随访时间等因素,各研究所得结果差异较大。有关缺血性脑卒中后痫性发作仍有一些问题需要更深入地研究,以期为临床防治、康复及健康教育提供依据。目的：探究老年患者急性缺血性卒中后痫性发作的发生率、危险因素及临床特点。方法：回顾性收集2013年07月至2015年06月在东南大学附属中大医院神经内科住院治疗,并首次诊断急性缺血性卒中患者的临床信息。收集患者的一般资料(性别及年龄)、既往史(高血压及糖尿病)、有无脑萎缩、皮质是否受累、皮质受累脑叶、血清甘油三酯水平、血清胆固醇水平、糖化血红蛋白水平、首次痫性发作时间及发作类型,最长随访时间30个月。急性缺血性脑卒中继发痫性发作的患者依据痫性发作的发生时间分为早期痫性发作组和晚期痫性发作组。早期痫性发作定义为急性脑卒中后14天内的痫性发作。痫性发作根据发作类型分为部分性发作和全面性发作,前者包括单纯部分性发作及复杂部分性发作。早期痫性发作的发作类型由住院期间病历信息获得；晚期痫性发作的发作类型通过电话回访获得。最终有900例患者纳入研究,其中痫性发作患者35例。对急性缺血性卒中后痫性发作的危险因素和临床特点进行分析、归纳和总结。对资料先进行单因素分析,后进行多因素Logistic回归分析。结果：在900例(男性64%,平均年龄69.87±12.16岁)急性缺血性卒中患者中,有35例(男性57.1%,平均年龄74.06±10.47岁)患者出现痫性发作,发病率为3.8%。与865例(男性64.3%,平均年龄69.70±12.20岁)无痫性发作患者相比,高龄(p=0.038)及皮质受累(p=0.000)是痫性发作的危险因素,且皮质受累是痫性发作的独立危险因素；另发现左额叶(p=0.007)及右颞叶(p=0.039)皮质受累的缺血性卒中患者更易出现痫性发作,且经多元回归分析后仍具有显著统计学差异。性别、高血压、糖尿病、脑萎缩、血清甘油三酯水平、血清胆固醇水平及糖化血红蛋白水平对急性缺血性卒中后痫性发作无显著影响。但是,与晚期痫性发作相比,早期发作患者糖化血红蛋白水平较高。结论：高龄及皮质受累是卒中后痫性发作的危险因素,且皮质受累是卒中后痫性发作的独立危险因素,左额叶及右颞叶皮质受累急性缺血性卒中患者易继发痫性发作。相较于晚期痫性发作患者,早期痫性发作患者糖化血红蛋白水平较高。
[Abstract]:Background: stroke has become the first cause of death in China. Stroke includes ischemic stroke and hemorrhagic stroke, among which ischemic stroke is the most common type. Stroke is the most common cause of epileptic seizures in elderly patients. At the same time, epileptic seizures may affect the early treatment of stroke and further worsen the prognosis of stroke patients. Both stroke and epileptic seizures are a heavy burden for the patient, his family and society. At present, a series of studies have been carried out on the incidence, risk factors and clinical characteristics of epileptic seizures and epilepsy after ischemic stroke, but due to experimental design, sample size, follow-up time and other factors, The results of each study vary greatly. There are still some problems about epileptic seizure after ischemic stroke which need to be further studied in order to provide evidence for clinical prevention, rehabilitation and health education. Objective: to investigate the incidence, risk factors and clinical features of epilepsy after acute ischemic stroke in elderly patients. Methods: the clinical data of patients with acute ischemic stroke were collected retrospectively from July 2013 to June 2015 in Department of Neurology, affiliated Chinese University Hospital of Southeast University. General data (sex and age), past history (hypertension and diabetes), brain atrophy, cortical involvement, serum triglyceride level, serum cholesterol level, glycosylated hemoglobin level were collected. The duration and type of first seizure were followed up for 30 months. Patients with acute ischemic stroke were divided into early epileptic seizure group and late epileptic seizure group according to the time of epileptic seizure. Early epileptic seizures are defined as epileptic seizures within 14 days of acute stroke. Epileptic seizures are divided into partial seizures and comprehensive seizures according to their seizure types. The former includes simple partial seizures and complex partial seizures. The types of seizures in early stage were obtained from the information of medical records during hospitalization, and the types of seizures in late stage were obtained by telephone return visit. Finally, 900 patients were included in the study, including 35 patients with epileptic seizures. The risk factors and clinical features of epileptic seizures after acute ischemic stroke were analyzed, summarized and summarized. The data were analyzed by univariate analysis and then by multivariate Logistic regression analysis. Results: among 900 patients with acute ischemic stroke (male 64 and mean age 69.87 卤12.16), 35 patients (male 57.1, mean age 74.06 卤10.47) had epileptic seizures with an incidence of 3.8%. Compared with 865 patients (male 64.3 years, mean age 69.70 卤12.20 years) without epileptic seizure, old age (p0. 038) and cortical involvement (p0. 000) were risk factors of epileptic seizure. Cortical involvement was an independent risk factor for epileptic seizures. It was also found that ischemic stroke patients with cortical involvement in left frontal lobe (p0. 007) and right temporal lobe (p0. 039) were more likely to have epileptic seizures, and there were significant statistical differences after multiple regression analysis. Sex, hypertension, diabetes, brain atrophy, serum triglyceride level, serum cholesterol level and glycosylated hemoglobin level had no significant effect on epileptic seizure after acute ischemic stroke. However, the level of glycosylated hemoglobin in patients with early seizures was higher than that in late epileptic seizures. Conclusion: old age and cortical involvement are the risk factors of post-stroke epileptic seizure, and cortical involvement is an independent risk factor of post-stroke epileptic seizure. The patients with acute ischemic stroke with involvement of left frontal lobe and right temporal lobe cortex are prone to secondary epileptic seizure. Glycosylated hemoglobin levels were higher in early epileptic seizures than in late epileptic seizures.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

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