本文選題：癲癇 + 預后　； 參考：《西南醫(yī)科大學》2017年碩士論文

【摘要】：目的:探究影響中國西部地區(qū)新診斷成人癲癇患者抗癲癇藥物治療預后的相關(guān)因素。方法:通過對2014年1月至2015年12月來自四川省人民醫(yī)院、重慶醫(yī)科大學大學附屬醫(yī)院及四川大學華西醫(yī)院三個癲癇中心新診斷的癲癇患者進行連續(xù)性登記并隨訪,詳細記錄其性別、年齡、居住地、發(fā)病年齡、發(fā)作類型、病因及目前治療狀況等,進行描述性統(tǒng)計分析。結(jié)果:1.該研究共納入了806例癲癇患者,其中男性477例,女性329例,男女性別比例為1.45:1,各組在男女性別構(gòu)成比上無差異。2.各組之間居住地對療效的影響存在統(tǒng)計學差異,居住于城市患者390例,非城市農(nóng)村患者416例,居住于城市患者預后更好。3.起病年齡16~25歲143例占17.7%,26~40歲164例占20.3%,41~59歲197例占24.4%,≥60歲者302例占37.5%,中國西部地區(qū)癲癇的起病年齡以老年組(≥60歲)居多,且預后較差,16~25歲發(fā)病的預后較好。4.806例癲癇患者中特發(fā)性及隱源性癲癇325例(40.3%),癥狀性癲癇481例(59.7%),病因排名順次為腦卒中141例(29.3%)、海馬硬化84例(17.5%)、腦外傷66例(13.7%)、顱內(nèi)炎癥60例(12.5%)、皮質(zhì)發(fā)育畸形與其他腦發(fā)育不良30例(6.2%)、高熱驚厥附加癥30例(6.2%)、腦腫瘤術(shù)后27例(5.6%)、圍生期損傷12例(2.5%)、神經(jīng)退行性變9例(1.9%)、代謝及中毒性疾病9例(1.9%)、其它病因(包括動靜脈畸形、動脈瘤、結(jié)節(jié)性硬化、系統(tǒng)性紅斑狼瘡、藥源性、電擊傷、腦積水等)13例(2.7%);有明確病因的癲癇患者預后較差,經(jīng)全因素分析病因中海馬硬化和代謝及中毒性疾病所致癲癇患者預后更差。男性患者中最常見的病因順次為腦卒中61例(24.3%)、腦外傷46例(18.3%)、海馬硬化43例(17.1%)、顱內(nèi)炎癥33例(13.1%)、高熱驚厥附加癥21例(8.4%)、皮質(zhì)發(fā)育畸形及其他腦發(fā)育不良16例(6.4%)、腦腫瘤術(shù)后15例(6.0%)、圍生期損傷4例(1.6%)、神經(jīng)退行性病變3例(1.2%)、代謝性及中毒性疾病2例(0.8%)及其它少見病因7例(2.8%);女性患者中的最常見的病因順次為腦卒中80例(34.8%)、海馬硬化41例(17.8%)、顱內(nèi)炎癥27例(11.7%)、腦外傷20例(8.7%)、皮質(zhì)發(fā)育畸形14例(6.1%)、腦腫瘤12例(5.2%)、高熱驚厥附加癥9例(3.9%)、圍生期損傷8例(3.5%)、代謝性及中毒性疾病7例(3.0%)、神經(jīng)退行性病變6例(2.6%)、及其他少見病因6例(2.6%)。病因中男性患者腦外傷、高熱驚厥高于女性患者,女性患者腦卒中高于男性差異具有統(tǒng)計學意義;其余各病因之間無統(tǒng)計學差異。5.發(fā)作類型中局灶性癲癇患者318例占39.5%,全面性發(fā)作302例占37.5%,無法分類186例占23.0%,局灶性癲癇比例略高于全面性癲癇發(fā)作患者且預后較差。6.藥物治療中單藥治療686例占85.1%,2種及以上藥物者120例占14.9%,其中服用2種藥物者99例,2種以上藥物者21例。單藥治療藥物使用順次為左乙拉西坦227例(33.1%)、丙戊酸180例(26.2%)、奧卡西平136例(19.8%)、拉莫三嗪107例(15.6%)、卡馬西平18例(2.6%)、托吡酯13例(1.9%)、加巴噴丁2例(0.3%)苯妥英鈉1例(0.1%)、苯巴比妥1例(0.1%)、氯硝西泮1例(0.1%)。統(tǒng)計學分析單藥治療患者療效較多藥治療好。單藥治療中使用拉莫三嗪患者預后較好,余治療藥物無統(tǒng)計學差異。7.服藥過程中患者藥物依從性差的100例占12.4%,依從性好的患者706例占87.6%,經(jīng)統(tǒng)計分析依從性為影響預后的獨立危險因素。8.納入的806例患者腦電圖重度異常646例(80.1%),輕度異常160例(19.9%);有家族史患者17例(2.1%),無家族史患者789例(97.9%);夜間發(fā)作患者105例(13.0%),非夜間發(fā)作患者701例(87.0%);454例(71.7%)有婚姻史,429例(67.8%)有生育史,每天均有發(fā)作的210(26.1%)例,每周發(fā)作的51(6.3%)例,每月發(fā)作的187(23.2%)例,小于每月發(fā)作的358(44.4%)例;經(jīng)統(tǒng)計學分析腦電圖、發(fā)作頻率、家族史、夜間發(fā)作、婚育史與預后無統(tǒng)計學差異。9.多因素Logistic回歸分析提示非城市偏遠地區(qū)、起病年齡≥60歲、局灶性癲癇、多藥治療、藥物依從性差為預后不良的獨立危險因素。結(jié)論:1.中國西部地區(qū)老年組(起病年齡≥60歲)癲癇患者的預后較差,可能為中國西部地區(qū)隨著年齡的增加,癥狀性癲癇所占比例也相應(yīng)增加,同時西部地區(qū)男性使用摩托車等交通工具及多從事建筑行業(yè),容易發(fā)生腦外傷事故,導致腦外傷繼發(fā)癲癇比例較高,此類患者對抗癲癇藥物的反應(yīng)較差有關(guān)。2.中國西部地區(qū)局灶性癲癇所占的比例較高,可能與西部地區(qū)經(jīng)濟情況和地域狀況有關(guān),西部地區(qū)男性使用摩托車等交通工具及多從事建筑行業(yè),容易發(fā)生外傷事故,增加了局灶性癲癇的發(fā)生率,且此部分癲癇患者的預后較差。3.中國西部地區(qū)新診斷癲癇患者單藥治療比例較高且單藥治療無發(fā)作、顯效、有效率較高,可能與近年來相關(guān)癲癇的繼續(xù)培訓和患者科普教育提高了�？漆t(yī)師的癲癇規(guī)范化診療水平以及患者的依從性有關(guān)。4.癲癇患者對抗癲癇藥物治療的依從性是影響治療的獨立危險因素。中國西部地區(qū)近年來患者對診療的依從性有所提高,可能與�？婆嘤柦逃岣吡藢？漆t(yī)生診療水平和患者科普教育提高了患者的依從性有關(guān)。5.本研究提示,在中國西部地區(qū),居住于非城市偏遠地區(qū)、起病年齡≥60歲、局灶性癲癇、多藥治療、藥物依從性差為預后不良的獨立危險因素。而腦電圖、家族史、發(fā)作頻率雖無統(tǒng)計學差異,尚需進一步擴大樣本研究證實。
[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.

【學位授予單位】：西南醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R742.1

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