中枢神经系统棘球幼病(包虫病)癫痫发作的危险因素

doi:10.3969/j.issn.1004-583X.2024.08.006

摘要/Abstract

摘要：

目的分析中枢神经系统包虫病癫痫发作的危险因素。方法收集2016年1月-2024年1月青海大学附属医院神经内科、神经外科住院的中枢神经系统包虫病患者79例,分别设为癫痫发作组和非癫痫发作组,采用单因素分析及多因素logistic回归分析探究中枢神经系统包虫病癫痫发作的危险因素。结果中枢神经系统包虫病癫痫发作30例,癫痫发作的发生率为38.0%。单因素分析示包虫部位、包虫直径及包虫周围脑组织受压水肿与中枢神经系统包虫病癫痫发作有相关性(均P<0.05)。Logistic回归分析示包虫位于皮层部位、包虫周围脑组织受压水肿是中枢神经系统包虫病癫痫发作的独立危险因素。结论中枢神经系统包虫病癫痫发作在青海地区发生率远较其他流行地区高,包虫位于皮层部位、包虫周围脑组织受压水肿是癫痫发作的独立危险因素,可采取针对性措施进行预防和治疗。

关键词: 棘球幼病, 中枢神经系统疾病, 癫痫, 危险因素

Abstract:

Objective To investigate the risk factors of seizures in patients with central nervous system (CNS) cystic echinococcosis (CE). Methods A total of 79 patients with CNS CE admitted to the Department of Neurology and Neurosurgery of Qinghai University Affiliated Hospital from January 2016 to January 2024 were enrolled. They were assigned into the seizure group and non-seizure group. Univariate and multivariate logistic regression analyses were used to analyze the risk factors of seizures in patients with CNS CE. Results There were 30 (38.0%) patients with CNS CE in the seizure group. Univariate logistic regression showed that the site, diameter and surrounding brain tissue edema were significantly correlated with the attack of seizure in patients with CNS CE (P<0.05). Multivariate logistic regression showed that cortical localization, and surrounding brain tissue edema were risk factors of seizure in patients with CNS CE (P<0.05). Conclusion The incidence of seizure in patients with CNS CE is 38.0%. Cortical localization, and surrounding brain tissue edema are risk factors of seizure in patients with CNS CE. Targeted approaches can be made to prevent and treat CNS CE.

Key words: echinococcosis, central nervous system diseases, epilepsy, risk factors

中图分类号:

R532.32

焦菲, 姚治平, 王兰桂. 中枢神经系统棘球幼病(包虫病)癫痫发作的危险因素[J]. 临床荟萃, 2024, 39(8): 712-715.

Jiao Fei, Yao Zhiping, Wang Langui. Risk factors of seizures in patients with central nervous system cystic echinococcosis[J]. Clinical Focus, 2024, 39(8): 712-715.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.08.006

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I8/712

图/表 3

表1 两组基本资料比较

Tab.1 Basic data of two groups

组别		例数	年龄(岁)		性别[例(%)]		民族[例(%)]		海拔[例(%)]		包虫类型[例(%)]		头痛[例(%)]
组别		例数	年龄(岁)		男	女	藏族	汉族	中高海拔	高海拔	囊型	泡型	有	无
癫痫发作组		30	39.50±14.38		23(76.7)	7(23.3)	24(80.0)	6(20.0)	5(16.7)	25(83.3)	2(6.7)	28(93.3)	25(83.3)	5(16.7)
非癫痫发作组		49	35.84±13.69		27(55.1)	22(44.9)	41(83.7)	8(16.3)	4(8.2)	45(91.8)	1(2.0)	48(98.0)	43(87.8)	6(12.2)
$t$ /χ²值			-1.132		3.724		0.175		0.624		0.191		0.047
$P$ 值			0.261		0.054		0.678		0.430		0.662		0.829
组别	嗜酸性粒细胞[例(%)]				嗜碱性粒细胞[例(%)]		部位[例(%)]		脑组织受压水肿[例(%)]		直径[例(%)]		病灶数量[例(%)]
组别	正常			异常	正常	异常	皮层	非皮层	有	无	<3 cm	≥3 cm	<3个	≥3个
癫痫发作组	8(26.7)			22(73.3)	23(76.7)	7(23.3)	27(90.0)	3(10.0)	19(63.3)	11(36.7)	27(90.0)	3(10.0)	19(63.3)	11(36.7)
非癫痫发作组	8(16.3)			41(83.7)	32(65.3)	17(34.7)	29(59.2)	20(40.8)	18(36.7)	31(63.3)	33(67.3)	16(32.7)	32(65.3)	17(34.7)
χ²值	1.232				1.135		8.562		5.287		5.227		0.032
$P$ 值	0.267				0.287		0.003		0.021		0.022		0.859

表1 两组基本资料比较

Tab.1 Basic data of two groups

组别		例数	年龄(岁)		性别[例(%)]		民族[例(%)]		海拔[例(%)]		包虫类型[例(%)]		头痛[例(%)]
组别		例数	年龄(岁)		男	女	藏族	汉族	中高海拔	高海拔	囊型	泡型	有	无
癫痫发作组		30	39.50±14.38		23(76.7)	7(23.3)	24(80.0)	6(20.0)	5(16.7)	25(83.3)	2(6.7)	28(93.3)	25(83.3)	5(16.7)
非癫痫发作组		49	35.84±13.69		27(55.1)	22(44.9)	41(83.7)	8(16.3)	4(8.2)	45(91.8)	1(2.0)	48(98.0)	43(87.8)	6(12.2)
$t$ /χ²值			-1.132		3.724		0.175		0.624		0.191		0.047
$P$ 值			0.261		0.054		0.678		0.430		0.662		0.829
组别	嗜酸性粒细胞[例(%)]				嗜碱性粒细胞[例(%)]		部位[例(%)]		脑组织受压水肿[例(%)]		直径[例(%)]		病灶数量[例(%)]
组别	正常			异常	正常	异常	皮层	非皮层	有	无	<3 cm	≥3 cm	<3个	≥3个
癫痫发作组	8(26.7)			22(73.3)	23(76.7)	7(23.3)	27(90.0)	3(10.0)	19(63.3)	11(36.7)	27(90.0)	3(10.0)	19(63.3)	11(36.7)
非癫痫发作组	8(16.3)			41(83.7)	32(65.3)	17(34.7)	29(59.2)	20(40.8)	18(36.7)	31(63.3)	33(67.3)	16(32.7)	32(65.3)	17(34.7)
χ²值	1.232				1.135		8.562		5.287		5.227		0.032
$P$ 值	0.267				0.287		0.003		0.021		0.022		0.859

表2 中枢神经系统包虫病癫痫发作的多因素logistic回归分析

Tab.2 Multivariate logistic regression analysis of seizures in central nervous system cystic echinococcosis

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
包虫部位	2.775	0.720	14.872	<0.001	16.035	3.914	65.693
周围脑组织受压水肿	1.158	0.584	6.746	0.009	4.562	1.451	14.339
包虫直径	-0.576	0.610	0.892	0.345	0.562	0.170	1.859
常量	-2.812	0.789	12.687	<0.001	0.060

表2 中枢神经系统包虫病癫痫发作的多因素logistic回归分析

Tab.2 Multivariate logistic regression analysis of seizures in central nervous system cystic echinococcosis

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
包虫部位	2.775	0.720	14.872	<0.001	16.035	3.914	65.693
周围脑组织受压水肿	1.158	0.584	6.746	0.009	4.562	1.451	14.339
包虫直径	-0.576	0.610	0.892	0.345	0.562	0.170	1.859
常量	-2.812	0.789	12.687	<0.001	0.060

表3 癫痫发作类型比较

Tab.3 Comparison of seizure types

癫痫发作类型	例数	构成比(%)
局灶起始发作
意识清醒/意识障碍	1	3.3
运动症状起病	3	10.0
非运动症状起病	0	0
局灶性进展为双侧强直-阵挛	5	16.7
全面性起源
运动症状起病	2	6.7
强直-阵挛发作	19	63.3
其他运动症状	0	0
非运动症状起病	0	0
起源不明
运动症状起病	0	0
非运动症状起病	0	0
不能分类的发作	0	0

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