迟发性卒中后癫痫的危险因素及其与血Hcy、hs-CRP和D-D的相关性

doi:10.3969/j.issn.1004-583X.2023.10.005

摘要/Abstract

摘要： 目的分析迟发性卒中后癫痫(delayed post-stroke epilepsy, dPSE)的危险因素及血同型半胱氨酸(homocysteine,Hcy)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)和D-二聚体(D-dimer,D-D)水平与dPSE的临床相关性。方法回顾性分析2021年2月-2023年5月宿州市立医院确诊并收治的dPSE患者34例(癫痫组);选取同一时期仅确诊急性缺血性脑卒中患者41例(对照组)。比较两组临床资料差异,采用多因素Logistic回归分析dPSE的独立危险因素,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),通过曲线下面积(area under curve,AUC)评价血Hcy、hs-CRP对dPSE的预测价值。结果两组饮酒史、NIHSS评分、卒中范围、卒中部位、血清Hcy、血浆hs-CRP水平差异均有统计学意义(P<0.05),而性别、年龄、吸烟史、高血压病史、糖尿病史、冠状动脉粥样硬化性心脏病史、脑血管疾病家族史、D-D水平差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,饮酒史、入院时NIHSS评分、脑卒中病灶位于皮层、血Hcy及血浆hs-CRP高表达均是dPSE的独立危险因素(OR=4.296、1.277、5.373、1.094、1.040, P<0.05)。ROC曲线显示,血清Hcy预测dPSE的最佳截断点为13.900 μmol/L(AUC=0.683),血浆hs-CRP预测dPSE的最佳截断点为8.505 mg/L(AUC=0.693)。结论饮酒史、入院时 NIHSS评分、脑卒中病灶位于皮层、血清Hcy及血浆hs-CRP水平均为dPSE的独立危险因素。血浆D-D与dPSE未显示明确临床相关性,血清Hcy、血浆hs-CRP水平对急性缺血性卒中患者是否继发癫痫有重要的预测价值,可作为dPSE的预测因子。

关键词: 癫痫, 缺血性卒中, 危险因素, 同型半胱氨酸, 超敏C反应蛋白, D-二聚体

Abstract: Objective To analyze the risk factors for delayed post-stroke epilepsy (dPSE) and its clinical correlation with blood homocysteine (Hcy), hypersensitive C-reactive protein (hs-CRP) and D-dimer (D-D) levels. Methods It was a retrospective analysis involving 34 dPSE patients (epilepsy group) diagnosed and treated in Suzhou Municipal Hospital from February 2021 to May 2023. During the same period, 41 patients with acute ischemic stroke were selected as the control group. The clinical data were compared between groups. Multivariate Logistic regression was performed to analyze risk factors for dPSE. The predictive value of blood Hcy, hs-CRP and D-D in dPSE was analyzed by plotting the receiver operating characteristic (ROC) curves and calculating the area under curve (AUC). Results There were significant differences in alcohol history, the National Institutes of Health Stroke Scale (NIHSS) score, range of stroke, location of the infarcted lesions, serum Hcy and plasma hs-CRP between groups (P<0.05). There were no significant differences in the sex, age, history of smoking, hypertension, diabetes mellitus and coronary atherosclerotic heart disease, family history of cerebrovascular diseases and D-D level between groups (P>0.05). Logistic regression analysis showed that alcohol history, NIHSS score on admission, infarcted lesion in the cortex and high expression levels of Hcy and hs-CRP were the risk factors for dPSE (OR=4.296, 1.277, 5.373, 1.094, 1.040, P<0.05). ROC curves showed that the optimal cut-off values of serum Hcy and plasma hs-CRP in predicting dPSE was 13.900 μmol/L(AUC=0.683) and 8.505 mg/L (AUC=0.693), respectively. Conclusion Alcohol history, NIHSS score on admission, infarcted lesion in the cortex and high expression levels of Hcy and hs-CRP are the risk factors for dPSE. There is no clear correlation between plasma D-D and dPSE. Serum Hcy and plasma hs-CRP have important predictive values for secondary epilepsy in patients with acute ischemic stroke, which can be used as predictors of dPSE.

Key words: epilepsy, ischemic stroke, risk factors, homocysteine, hypersensitive C-reactive protein, D-dimer

中图分类号:

R742.1

丁思奇, 刘时华, 张超, 钟平, 曹立. 迟发性卒中后癫痫的危险因素及其与血Hcy、hs-CRP和D-D的相关性[J]. 临床荟萃, 2023, 38(10): 893-897.

Ding Siqi, Liu Shihua, Zhang Chao, Zhong Ping, Cao Li. Risk factors for epilepsy after delayed post-stroke epilepsy and its clinical correlation with blood Hcy, hs-CRP and D-D[J]. Clinical Focus, 2023, 38(10): 893-897.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.10.005

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I10/893

图/表 4

表1 两组临床数据比较

Tab. 1 Comparison of clinical data between groups

组别	例数		性别[例(%)]			年龄 (岁)		吸烟史 [例(%)]		饮酒史 [例(%)]		冠状动脉粥样硬化性心脏病史 [例(%)]		高血压病史 [例(%)]		糖尿病史 [例(%)]		脑血管疾病家族史 [例(%)]
			男		女
			对照组	41															25(61.0)	16(39.0)	67.98±11.70	21(51.2)	7(17.1)	23(56.1)	30(73.2)	10(24.4)	24(58.5)
癫痫组	34		24(70.6)		10(29.4)	63.26±14.21		10(29.4)		6(17.7)		10(29.4)		20(58.8)		12(35.3)		17(50.0)
统计值			χ²=0.758			$t$ =0.636		χ²=3.645		χ²=0.004		χ²=5.372		χ²=1.722		χ²=1.066		χ²=0.547
$P$ 值			0.384			0.120		0.056		0.948		0.020		0.189		0.302		0.460
组别		卒中范围[例(%)]					卒中部位[例(%)]				NIHSS评分 (分)		Hcy (μmol/L)		hs-CRP (mg/L)		D-D (μg/mL)
组别		多脑叶		单脑叶			皮层		皮层下		NIHSS评分 (分)		Hcy (μmol/L)		hs-CRP (mg/L)		D-D (μg/mL)
对照组		17(41.5)		24(58.5)			10(24.4)		31(75.6)		4.00±3.17		13.82±7.11		6.28±14.30		0.60±0.93
癫痫组		28(82.4)		6(17.7)			17(50.0)		17(50.0)		7.79±4.40		21.89±15.90		16.58±21.17		1.27±1.82
统计值		χ²=12.948					χ²=5.291				$t$ =-4.207		$t$ =-2.742		$t$ =-2.416		$t$ =-1.956
$P$ 值		0.000					0.021				0.000		0.009		0.019		0.057

表1 两组临床数据比较

Tab. 1 Comparison of clinical data between groups

组别	例数		性别[例(%)]			年龄 (岁)		吸烟史 [例(%)]		饮酒史 [例(%)]		冠状动脉粥样硬化性心脏病史 [例(%)]		高血压病史 [例(%)]		糖尿病史 [例(%)]		脑血管疾病家族史 [例(%)]
			男		女
			对照组	41															25(61.0)	16(39.0)	67.98±11.70	21(51.2)	7(17.1)	23(56.1)	30(73.2)	10(24.4)	24(58.5)
癫痫组	34		24(70.6)		10(29.4)	63.26±14.21		10(29.4)		6(17.7)		10(29.4)		20(58.8)		12(35.3)		17(50.0)
统计值			χ²=0.758			$t$ =0.636		χ²=3.645		χ²=0.004		χ²=5.372		χ²=1.722		χ²=1.066		χ²=0.547
$P$ 值			0.384			0.120		0.056		0.948		0.020		0.189		0.302		0.460
组别		卒中范围[例(%)]					卒中部位[例(%)]				NIHSS评分 (分)		Hcy (μmol/L)		hs-CRP (mg/L)		D-D (μg/mL)
组别		多脑叶		单脑叶			皮层		皮层下		NIHSS评分 (分)		Hcy (μmol/L)		hs-CRP (mg/L)		D-D (μg/mL)
对照组		17(41.5)		24(58.5)			10(24.4)		31(75.6)		4.00±3.17		13.82±7.11		6.28±14.30		0.60±0.93
癫痫组		28(82.4)		6(17.7)			17(50.0)		17(50.0)		7.79±4.40		21.89±15.90		16.58±21.17		1.27±1.82
统计值		χ²=12.948					χ²=5.291				$t$ =-4.207		$t$ =-2.742		$t$ =-2.416		$t$ =-1.956
$P$ 值		0.000					0.021				0.000		0.009		0.019		0.057

表2 dPSE的多因素 Logistic回归分析

Tab. 2 Multivariate Logistic regression analysis of dPSE

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
饮酒史	1.458	0.680	4.599	0.032	4.296	1.134	16.282
卒中范围	-0.983	0.702	1.962	0.161	0.374	0.095	1.481
卒中部位	1.681	0.742	5.138	0.023	5.373	1.256	22.993
入院时NIHSS评分(分)	0.204	0.103	3.962	0.047	1.227	1.003	1.500
Hcy(μmol/L)	0.090	0.041	4.735	0.030	1.094	1.009	1.186
hs-CRP(mg/L)	0.039	0.018	4.755	0.029	1.040	1.004	1.077

表2 dPSE的多因素 Logistic回归分析

Tab. 2 Multivariate Logistic regression analysis of dPSE

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
饮酒史	1.458	0.680	4.599	0.032	4.296	1.134	16.282
卒中范围	-0.983	0.702	1.962	0.161	0.374	0.095	1.481
卒中部位	1.681	0.742	5.138	0.023	5.373	1.256	22.993
入院时NIHSS评分(分)	0.204	0.103	3.962	0.047	1.227	1.003	1.500
Hcy(μmol/L)	0.090	0.041	4.735	0.030	1.094	1.009	1.186
hs-CRP(mg/L)	0.039	0.018	4.755	0.029	1.040	1.004	1.077

图1 血清 Hcy、血浆hs-CRP预测dPSE的ROC曲线

Fig.1 ROC curves of serum Hcy and plasma hs-CRP in predicting dPSE

表3 Hcy和hs-CRP对dPSE的预测价值

Tab. 3 Predictive value of Hcy and hs-CRP for dPSE

检测指标	AUC	标准误	$P$ 值	95% $C I$		灵敏度	特异度	最佳截断值	约登指数
检测指标	AUC	标准误	$P$ 值	下限	上限	灵敏度	特异度	最佳截断值	约登指数
Hcy(μmol/L)	0.683	0.063	0.007	0.559	0.807	67.7	65.9	13.900	33.6
hs-CRP(mg/L)	0.693	0.063	0.004	0.567	0.817	52.9	85.4	8.505	38.3

表3 Hcy和hs-CRP对dPSE的预测价值

Tab. 3 Predictive value of Hcy and hs-CRP for dPSE

检测指标	AUC	标准误	$P$ 值	95% $C I$		灵敏度	特异度	最佳截断值	约登指数
检测指标	AUC	标准误	$P$ 值	下限	上限	灵敏度	特异度	最佳截断值	约登指数
Hcy(μmol/L)	0.683	0.063	0.007	0.559	0.807	67.7	65.9	13.900	33.6
hs-CRP(mg/L)	0.693	0.063	0.004	0.567	0.817	52.9	85.4	8.505	38.3

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