【摘要】：背景：目前,在我國腦卒中已經(jīng)超過惡性腫瘤成為第一致死原因。腦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見的類型。在老年患者,卒中是癇性發(fā)作最常見的原因。同時,癇性發(fā)作會影響卒中的早期治療,并進一步惡化卒中患者預后。不論是卒中亦或癇性發(fā)作對于患者本人、家庭及社會都是沉重的負擔。目前國內外針對缺血性卒中后癇性發(fā)作及癲癇的發(fā)病率、危險因素及臨床特點等進行了一系列的研究,但是由于實驗設計、樣本量、隨訪時間等因素,各研究所得結果差異較大。有關缺血性腦卒中后癇性發(fā)作仍有一些問題需要更深入地研究,以期為臨床防治、康復及健康教育提供依據(jù)。目的：探究老年患者急性缺血性卒中后癇性發(fā)作的發(fā)生率、危險因素及臨床特點。方法：回顧性收集2013年07月至2015年06月在東南大學附屬中大醫(yī)院神經(jīng)內科住院治療,并首次診斷急性缺血性卒中患者的臨床信息。收集患者的一般資料(性別及年齡)、既往史(高血壓及糖尿病)、有無腦萎縮、皮質是否受累、皮質受累腦葉、血清甘油三酯水平、血清膽固醇水平、糖化血紅蛋白水平、首次癇性發(fā)作時間及發(fā)作類型,最長隨訪時間30個月。急性缺血性腦卒中繼發(fā)癇性發(fā)作的患者依據(jù)癇性發(fā)作的發(fā)生時間分為早期癇性發(fā)作組和晚期癇性發(fā)作組。早期癇性發(fā)作定義為急性腦卒中后14天內的癇性發(fā)作。癇性發(fā)作根據(jù)發(fā)作類型分為部分性發(fā)作和全面性發(fā)作,前者包括單純部分性發(fā)作及復雜部分性發(fā)作。早期癇性發(fā)作的發(fā)作類型由住院期間病歷信息獲得；晚期癇性發(fā)作的發(fā)作類型通過電話回訪獲得。最終有900例患者納入研究,其中癇性發(fā)作患者35例。對急性缺血性卒中后癇性發(fā)作的危險因素和臨床特點進行分析、歸納和總結。對資料先進行單因素分析,后進行多因素Logistic回歸分析。結果：在900例(男性64%,平均年齡69.87±12.16歲)急性缺血性卒中患者中,有35例(男性57.1%,平均年齡74.06±10.47歲)患者出現(xiàn)癇性發(fā)作,發(fā)病率為3.8%。與865例(男性64.3%,平均年齡69.70±12.20歲)無癇性發(fā)作患者相比,高齡(p=0.038)及皮質受累(p=0.000)是癇性發(fā)作的危險因素,且皮質受累是癇性發(fā)作的獨立危險因素；另發(fā)現(xiàn)左額葉(p=0.007)及右顳葉(p=0.039)皮質受累的缺血性卒中患者更易出現(xiàn)癇性發(fā)作,且經(jīng)多元回歸分析后仍具有顯著統(tǒng)計學差異。性別、高血壓、糖尿病、腦萎縮、血清甘油三酯水平、血清膽固醇水平及糖化血紅蛋白水平對急性缺血性卒中后癇性發(fā)作無顯著影響。但是,與晚期癇性發(fā)作相比,早期發(fā)作患者糖化血紅蛋白水平較高。結論：高齡及皮質受累是卒中后癇性發(fā)作的危險因素,且皮質受累是卒中后癇性發(fā)作的獨立危險因素,左額葉及右顳葉皮質受累急性缺血性卒中患者易繼發(fā)癇性發(fā)作。相較于晚期癇性發(fā)作患者,早期癇性發(fā)作患者糖化血紅蛋白水平較高。
[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 鹵12.16), 35 patients (male 57.1, mean age 74.06 鹵10.47) had epileptic seizures with an incidence of 3.8%. Compared with 865 patients (male 64.3 years, mean age 69.70 鹵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.
【學位授予單位】：東南大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R743.3

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