急性脑卒中并发癫痫患者的临床特征及其危险因素研究

摘要

目的：探讨急性脑卒中并发癫痫患者的临床特征及其危险因素。方法选取2013年1月—2016年1月广西桂东人民医院收治的急性脑卒中患者230例，根据是否并发癫痫分为癫痫组21例和非癫痫组209例。采用自制的资料收集表收集两组患者的临床资料，分析急性脑卒中并发癫痫患者的临床特征，并采用多因素 logistic 回归模型筛选急性脑卒中患者并发癫痫的危险因素。结果21例癫痫患者病灶位于皮质上者15例，皮质下者6例；癫痫发作时间：早发性癫痫16例，迟发性癫痫5例；癫痫发作类型：大发作13例，单纯局限性运动性发作6例，精神运动性发作及小发作各1例；癫痫发作次数：单次发作15例，反复多次发作6例。两组患者性别、年龄及有无高血压、糖尿病、高脂血症、吸烟史、饮酒史比较，差异均无统计学意义（P ﹥0.05）；两组患者卒中类型、有无发热、有无意识障碍、病灶是否累及皮质及有无低钙血症比较，差异无统计学意义（P ﹤0.05）。多因素 logistic 回归分析结果显示，卒中类型〔OR =2.832，95% CI（1.391，5.766）〕、发热〔 OR =2.230，95% CI（1.132，4.393）〕、意识障碍〔 OR =2.977，95% CI（1.556，5.697）〕及病灶累及皮质〔OR =4.860，95% CI（1.260，10.074）〕是急性脑卒中患者并发癫痫的独立危险因素（P ﹤0.05）。结论急性脑卒中并发癫痫患者多表现为早发性皮质上单次大发作，卒中类型、发热、意识障碍及病灶累及皮质是急性脑卒中患者并发癫痫的独立危险因素。%Objective To investigate the clinical features of acute stroke patients complicated with epilepsy and the risk factors. Methods A total of 230 patients with acute stroke were selected in the People's Hospital of East Guangxi from January 2013 to January 2016,and they were divided into A group(complicated with epilepsy,n = 21)and B group(did not complicate with epilepsy,n = 209)according to the incidence of epilepsy. Self - made data collection table was used to collect the clinical data of the two groups and the clinical features were analyzed,multivariate logistic regression analysis was used to analyze the risk factors of epilepsy in patients with acute stroke. Results Of the 21 patients with epilepsy,15 cases'nidi located in cortex,6 cases'nidi located in subcortex;16 cases were early - onset epilepsy,5 cases were late - onset seizures;13 cases were grand mal,6 cases were simple focal motor seizures,1 case was psychomotor seizures,1 case was petit mal;15 cases were single attack,6 cases were repeated attack. No statistically significant differences of gender,age,complicated with hypertension or not,complicated with diabetes or not,complicated with hyperlipidaemia or not,with smoking history or not,with drinking history or not was found between the two groups(P ﹥ 0. 05),while there were statistically significant differences of stroke types, complicated with fever or not,complicated with conscious disturbance or not,nidus involved cortex or not and complicated with hypocalcemia or not(P ﹤ 0. 05). Multivariate logistic regression analysis results showed that,stroke types〔OR = 2. 832,95%CI(1. 391,5. 766)〕,fever〔 OR = 2. 230,95% CI(1. 132,4. 393)〕,conscious disturbance〔 OR = 2. 977,95% CI (1. 556,5. 697)〕 and nidus involved cortex〔 OR = 4. 860,95% CI(1. 260,10. 074)〕 were independent risk factors of epilepsy in patients with acute stroke( P ﹤ 0. 05). Conclusion Acute stroke patients complicated with epilepsy mainly performed as early - onset cortex related single grand mal,meanwhile stroke types,fever,conscious disturbance and nidus involved cortex are independent risk factors of epilepsy in patients with acute stroke.