癫患者药物规范化治疗预后的前瞻性研究

Prognosis of standardized medication strategy in patients with epilepsy:aprospective analysis

目的探讨抗癫药物规范化治疗2年以上癫患者的预后及影响预后的危险因素。方法根据临床病史及脑电图确诊为癫,按照发作类型规范化药物治疗、定期随诊2年以上,630例癫患者中符合研究条件者108例。比较基线期3个月与规范化治疗2年后3个月平均每月癫发作频率。分析起病年龄、性别、规范化治疗前病程、病因、发作类型、发作类型种数、脑电图有无癫波、单药或联合用药8种因素与预后的关系。结果单因素分析中性别、发病年龄、病因分型、有无癫波与预后差异无统计学意义;规范化治疗前病程、发作类型、发作类型种数、单药/联合用药的预后有显著性差异(P<0.01);规范治疗前病程与预后呈简单线性关系;多因素二元Logistic回归进一步分析得出需多药治疗是预后不佳的重要预测因子。结论癫患者药物规范化治疗2年后有效率达到78.7%(P=0.001,OR=6.729);越早规范化治疗预后越好;需多药治疗是预后不佳的重要预测因子。

Objective To investigate the prognosis of patients with epilepsy by the standardization of treatment and analysis the influencing factors. Methods 108 patients were diagnosed as epilepsy by the clinical history and EEG, experienced standardized medication therapy and followed up more than two years. The effi- cacy was assessed by comparing the average frequency per month（AFM） of 3 months after two years＇normal- ized treatment to the baseline therapy. The relationship between prognosis and the eight risk factors was ana- lyzed. Results In single factor analysis, six groups have no statistic difference in gender, age of onset, pathoge- ny and epilepsy wave. But the course before standardized medication strategy,attack types, sum of attack types , mono-therapy/therapeutic alliance have significant statistic difference（P^0. 01 ）. There is a simple linear rela- tionship between the course before standardized medication strategy and prognosis. Binary logistic regression a- nalysis shows that combination therapy has significant influence on poor prognosis（P = 0. 001, OR = 6. 729）. Conclusions 78. 7 % patients showed a reduction in AFM. The earlier the standardized strategy is begun the better prognosis. Needing therapeutic alliance is the important predictors of prognosis.