Risk factors for epilepsy after delayed post-stroke epilepsy and its clinical correlation with blood Hcy, hs-CRP and D-D

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

Abstract

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

CLC Number:

R742.1

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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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.10.005

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

Figures/Tables 4

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

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

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

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

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

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

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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