[1]黎玉丹 汪雨萱 李竞一等.新诊断癫痫患者药物治疗的长期结局及其影响因素[J].卒中与神经疾病杂志,2021,28(02):192-196.[doi:10.3969/j.issn.1007-0478.2021.02.013]
　Li Yudan,Wang Yuxuan,Li Jingyi,et al.Long-term outcomes and influencing factors of drug therapy in newly diagnosed epilepsy patients[J].Stroke and Nervous Diseases,2021,28(02):192-196.[doi:10.3969/j.issn.1007-0478.2021.02.013]
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新诊断癫痫患者药物治疗的长期结局及其影响因素()
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《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第28卷
期数:
2021年02期
页码:
192-196
栏目:
论 著
出版日期:
2021-04-20

文章信息/Info

Title:
Long-term outcomes and influencing factors of drug therapy in newly diagnosed epilepsy patients
文章编号:
1007-0478(2021)02-0192-05
作者:
黎玉丹 汪雨萱 李竞一等
430060 武汉大学人民医院神经内科[黎玉丹 汪雨萱 李竞一 李蓉 潘松青(通信作者)]
Author(s):
Li Yudan;  Wang Yuxuan;  Li Jingyi;  et al.
Department of Neurology, Renmin Hospital of Wuhan University, Wuhan 430060
关键词:
新诊断癫痫 长期结局 无发作率 影响因素
Keywords:
Newly diagnosed epilepsy Long-term outcome Seizure-free rate Influencing factor
分类号:
R742.1
DOI:
10.3969/j.issn.1007-0478.2021.02.013
文献标志码:
A
摘要:
目的 探讨抗癫痫药物治疗新诊断癫痫患者的长期结局及影响长期结局的因素。方法 收集武汉大学人民医院癫痫库中2009年3月1日-2014年10月31日就诊的癫痫患者,回顾性分析患者在随访期间随时间而变化的药物反应(≥1、≥2、≥3年无发作率),并根据末次随访时是否达到至少3年无发作分为控制组和未控制组,探讨影响患者长期结局的临床因素; 对连续变量和分类变量分别采用t检验和卡方检验,采用单因素分析比较2组的临床资料,多元逻辑回归分析影响长期结局的因素。结果 本研究共纳入350例新诊断癫痫患者。1、2、3年无发作率分别为68.3%、61.1%、59.1%; 2年及3年无发作率明显低于1年无发作率(239/350,68.3% vs.214/350,61.1%,P=0.048)、(239/350,68.3% vs.207/350,59.1%,P=0.012),但2年和3年无发作率(214/350,61.1% vs.207/350,59.1%,P=0.589)无明显差异。其中至少3年无发作(控制组)207例(59.1%),未控制组143例(40.9%),单因素分析显示治疗期间有多种发作类型比只有一种发作类型的患者3年无发作率低(10/49,20.4% vs.197/301,65.4%,P<0.001)、有围产期损伤史的患者3年无发作率比无围产期损伤者要低(6/24,25.0% vs.201/326,61.7%,P<0.001)、多药治疗的患者比单药治疗的患者3年无发作率低(54/153,35.3% vs.153/197,77.7%,P<0.001)、早期6个月仍有发作的患者比早期6个月无发作的患者3年无发作率低(71/151,47.0% vs.136/199,68.3%, P<0.001); 进一步多因素回归分析发现治疗期间多种发作类型[优势比(OR)=4.054,95%置信区间(CI)=1.834～8.958,P=0.001]、多药治疗(OR=5.192,95%CI=2.911～9.261,P<0.001)和有围产期损伤史(OR=5.475,95%CI=1.924～15.580,P=0.001)是不能获得3年无发作的预测因素。结论 新诊断癫痫患者随着时间延长无发作率呈下降趋势,3年无发作率为59.1%; 多种发作类型、多药治疗、围产期损伤是影响新诊断癫痫患者药物治疗长期结局的独立危险因素。
Abstract:
ObjectiveTo explore the long-term outcome of newly diagnosed epilepsy patients treated with antiepileptic drugs and its influencing factors.Methods Patients with epilepsy who visited the epilepsy database of Renmin Hospital of Wuhan University from March 1,2009 to October 31,2014 were collected and their drug reactions with time(1-year、2-year、3-year seizure-free rate)during follow-up were analyzed retrospectively. The patients were divided into control group and non-control group according to whether they had no seizure for at least 3 years at the last follow-up to explore the clinical factors affecting the long-term outcome.Results A total of 350 newly diagnosed epilepsy patients were included in this study. The 1-year, 2-year and 3-year seizure-free rates were 68.3%, 61.1% and 59.1%, respectively, at the end of follow-up. The 2-year and 3-year seizure-free rates were significantly lower than the 1-year seizure-free rate(239/350,68.3% vs.214/350,61.1%,P=0.048)and(239/350,68.3% vs.207/350,59.1%, P=0.012), but the 2-year and 3-year seizure-free rates(214/350,61.1% vs.207/350,59.1%, P=0.589)were not statistically different. Among them, 207(59.1%)had no seizure for at least 3 years(control group), and 143(40.9%)in non-control group. Univariate analysis showed that the 3-year seizure-free rate of patients with multiple seizure types during treatment was lower than that of patients with only one seizure type(10/49,20.4% vs.197/301,65.4%, P<0.001),the 3-year seizure-free rate of patients with a history of perinatal injury was lower than that of patients without perinatal injury(6/24,25.0% vs.201/326,61.7%,P<0.001),patients with polytherapy had a lower 3-year seizure-free rate than those with monotherapy(54/153,35.3% vs.153/197,77.7%,P<0.001), and those who still had seizures in the first 6 months had a lower 3-year seizure-free rate than those who did not have seizures in the first 6 months(71/151,47.0% vs.136/199,68.3%, P<0.001).Further multivariate regression analysis revealed that multiple seizure types [odds ratio(OR)=4.054,95% confidence interval(CI)=1.834～8.958,P=0.001], polytherapy(OR=5.192,95% CI=2.911～9.261, P<0.001)and a history of perinatal injury(OR=5.475,95% CI=1.924～15.580,P=0.001)were predictors of not achieving 3-year seizure-free.Conclusion The seizure-free rate of newly diagnosed epilepsy patients decreased with the prolongation of time, and the 3-year rate was 59.1%. Multiple seizure types, polytherapy and perinatal injury are independent risk for the long-term outcome of newly diagnosed epilepsy patients treated with medication.

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更新日期/Last Update: 2021-04-20