影响颞叶癫癎预后的危险因素分析

Analysis of risk factors for prognosis of temporal lobe epilepsy

目的：探讨影响颞叶癫癎预后的危险因素，为临床合理治疗颞叶癫癎和判断预后提供依据。方法：采用病例对照研究，回顾性分析两组颞叶癫癎患者即药物难治组102例，药物控制良好组166例的临床资料，采用单因素分析和多因素Logistic回归模型分析影响颞叶癫癎预后的相关因素。结果：单因素分析表明合理药物治疗前病程长、初期发作频繁（〉4次／月）、围产期损伤、服药依从性差、具有神经系统疾患和有影像学异常等6个因素对颞叶癫癎的预后有不利影响（均P〈0．05），进一步进行多因素Logistic回归分析，筛选出合理治疗前病程长（OR=1．989，95％CI：1．071～3．692）、初期发作频率高（OR=10．393，95％CI：5．355～20．170）、服药依从性差（OR=5．151，95％CI：2．916～8．615）、具有神经系统疾患（OR=1．113，95％CI：0．564-4．448）和有影像学异常（OR=4．032，95％CI：2．160～7．526）是影响颞叶癫癎预后的独立危险因素。结论：合理药物治疗前病程长、初期发作频繁（〉4次／月）、患者服药依从性差、具有神经系统疾患和影像学异常是药物治疗颞叶癫癎的重要危险因素，具有这些因素的患者易发展成难治性癫癎。

Objective：To approach the risk factors for the prognosis of temporal lobe epilepsy in order to provide theoretical basis for rational therapy. Methods： A case-controlled study was conducted in 268 patients （102 with medically refractory temporal lobe epilepsy and 166 with medically controllable ep ilepsy）, reviewed the clinical data of the two groups. Single factor analysis and Logistic stepwise regressional analysis were done to realize the relationship between the influential factors and the prognosis of temporal lobe epilepsy. Results： Single factor analysis showed longer duration before taking reasonable medicine, more frequent seizures （〉4times/Month）, perinatal stage trauma, poor compliance with antiepileptic drugs, neurological disorders, and abnormal neurological imaging exerted adverse effects on the prognosis of temporal lobe epilepsy （P〈0.05）. Multiple factor Logistic regressional analysis screened out such factors including duration before taking reasonable medicine （OR= 1. 989,95 % CI： 1. 071 3. 692）,seizure frequency（OR= 10. 393,95% CI：5. 355-20. 170）, perinatal stage trauma （OR=5. 151, 95% CI：2. 916-8. 615）,neurological disorders（OR= 1. 113,95% CI：0. 564-4. 448）and abnormal neurological imaging（OR= 4. 032,950/00 CI： 2. 160-7. 526）as independent predictors for the prognosis of temporal lobe epilepsy. Conclusion： Long duration before taking reasonable medicine, high frequent seizure onset, poor compliance with antiepileptic drugs, neurological disorders and abnormal neurological imaging are important risk factors of refractory temporal lobe epilepsy. Patients with these risk factors will easily Suffer from refractory temporal lobe epilepsy.