【摘要】：目的 分析非酮癥高血糖性癲癇患者的性別、發(fā)病年齡、發(fā)病的誘因、發(fā)作分型、血糖及糖化血紅蛋白水平，頭部CT或MRI影像特點，腦電圖的特點以及治療轉歸等，提高對非酮癥高血糖性癲癇的認識和診治水平。 方法 回顧分析吉林大學第一醫(yī)院神經內科收治的50例臨床確診為非酮癥高血糖(NKH)性癲癇患者的臨床資料，歸納總結患者的性別、發(fā)病年齡、發(fā)病的誘因、發(fā)作分型、血糖及糖化血紅蛋白水平，頭部CT或MRI影像特點，腦電圖的特點以及治療轉歸等。 結果 本研究患者選自神經內科住院患者,年齡最小19歲，最大為77歲，年齡在20歲（含20歲）以下者1例，占2.00%；20到40歲之間（含40歲）者9例，占18.00%；40到60歲之間（含60歲）者20例，占40.00%，平均53.91歲，男性35例，女性15例，男:女=2.33：1，50例患者中癲癇起病前大多數(shù)有明確的誘因，其中有7例患者首次發(fā)現(xiàn)血糖升高，占14%，43例患者既往糖尿病病史，且43例患者起病前多數(shù)合并有明確誘因，未規(guī)律應用胰島素9例，占18%，不合理飲食4例占8%，感染、外傷、妊娠、劇烈運動15例，占30%，其中飲酒5例，占10%，還有不明原因10例，占20%。結合該50例患者的癲癇發(fā)作形式，按國際癲癇發(fā)作分類（1981），進一步將其分為ⅠA組（簡單部分性發(fā)作）11例，Ⅰ B組（復雜部分性發(fā)作）22例，Ⅰ C組(部分發(fā)作繼發(fā)全面發(fā)作)17例，對3組患者的空腹血糖最大值、最小值、平均值、三餐后2小時血糖最大值、最小值、平均值、糖化血紅蛋白最大值、最小值、平均值，入院時急檢血糖最大值、最小值、平均值分別進行統(tǒng)計分析，觀察各組發(fā)作類型與血糖水平，糖化血紅蛋白的均值是否相關，將IA組與IB組各項檢驗結果的均值進行分析，早餐后2小時血糖、晚餐后2小時血糖、糖化血紅蛋白、入院急檢血糖P值均小于0.05，有統(tǒng)計學意義。進一步將IA組與IC組各項檢驗結果的均值進行分析，發(fā)現(xiàn)各項結果P值均小于0.05，均有統(tǒng)計學意義。將IB組與IC組各項檢驗結果的均值進行分析，只有糖化血紅蛋白P值小于0.05，有統(tǒng)計學意義。50例患者在就診前以及住院過程中均有癲癇發(fā)作，Ⅰ A組11例患者表現(xiàn)為部分性發(fā)作,其中5例發(fā)作形式與文獻報道一致，出現(xiàn)特征性的“防御性抽搐”，表現(xiàn)為：偏側上肢或下肢強直，另外6例表現(xiàn)為局限性的面肌和口角抽動、偏側肢體抽動。IB組22例患者表現(xiàn)為復雜部分性發(fā)作，其中18例患者發(fā)作前有心前區(qū)不適、恐慌感，另外4例發(fā)作前沒有明顯先兆，22例患者發(fā)作進一步發(fā)展均出現(xiàn)意識障礙，合并運動停止、凝視或者合并一側肢體的強直抖動。IC組17例患者中7例為簡單部分性發(fā)作演變?yōu)閺碗s部分性發(fā)作，再演變全身性發(fā)作，另外10例直接由簡單部分性發(fā)作演變?yōu)槿硇园l(fā)作。同時發(fā)現(xiàn)該50例患者頭部CT中43例患者未見明顯異常，7例單側基底節(jié)區(qū)片狀或條形稍高或高密度，邊界不清，CT值為30～50HU；行頭部MRI檢查結果顯示40例患者表現(xiàn)無異常，10例T1WI呈高信號， T2WI呈低信號。對50例患者腦電圖分析，IA組有8例患者腦電圖存在發(fā)作間期異常，表現(xiàn)為彌漫性慢波增多，合并少量額-顳區(qū)夾雜尖波和棘波發(fā)放，其余3例為邊緣腦電圖。IB組有20例患者腦電圖發(fā)作間期額區(qū)、顳區(qū)或枕區(qū)見較多中高幅欠規(guī)則尖波活動、尖慢波，12例臨床發(fā)作時見到典型發(fā)作期異常腦電圖，均為部分性發(fā)作腦電特點。IC組12例患者腦電圖發(fā)作間期出現(xiàn)同上異常，提示部分性發(fā)作腦電特點，10例出現(xiàn)典型發(fā)作期異常腦電圖，突然而廣泛的異常放電提示部分繼發(fā)全面發(fā)作。50例患者在住院期間治療原則是積極降低血糖,并注意糾正電解質紊亂，所有患者住院期間發(fā)作次數(shù)均較少或者停止發(fā)作，其中有7例患者住院期間在降低血糖的同時給予口服奧卡西平150mg2次/日或者托吡酯25mg1次/日，應用1周后停藥，在血糖控制良好的情況下停用抗癲癇藥物也未再發(fā)作。隨訪成功有17例患者，其中8例患者控制血糖良好，出院后未再出癲癇樣發(fā)作，其余9例患者仍因血糖控制不佳，有間斷發(fā)作。 結論 NKH性癲癇患者發(fā)生于各年齡段,以中老年男性合并糖尿病患者多見，誘因主要是不規(guī)律應用降糖藥物、感染、劇烈運動等導致的血糖升高。NKH性癲癇臨床表現(xiàn)及腦電特點多為部分性發(fā)作特點，并且病情嚴重程度與血糖高低及長期控制水平有關。NKH性癲癇通過糾正高血糖和補液等對癥支持治療可使病情迅速得到改善，，多數(shù)不需要系統(tǒng)抗癲癇藥物治療，但如果伴有癲癇持續(xù)狀態(tài)應在調節(jié)血糖的基礎上短時間應用抗癲癇藥物效果更好。大多數(shù)NKH性癲癇患者影像學檢查無異常，少數(shù)患者可以基底節(jié)區(qū)發(fā)現(xiàn)異常病變，CT表現(xiàn)為片狀或條形稍高或高密度，邊界不清，CT值為30～50HU，頭MRI T1WI呈高信號， T2WI呈低信號，上述影像學改變隨著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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R742.1

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