脑卒中后癫痫发作对患者认知损害及其血清神经元特异性烯醇化酶的动态变化

Cognitive impairment and changes in serum neuron specific enolase in patients with cerebral apoplexy after stroke

目的:探讨脑卒中后癫痫(post stroke epilepsy,PSE)发作对患者认知损害及其血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)的动态变化。方法:回顾性分析武汉市红十字医院和武汉大学人民医院2014年5月至2017年10月收治的156例脑卒中患者的临床资料,设80例脑卒中后无癫痫发作患者为对照组,76例PSE发作患者为观察组,比较两组认知功能损害。根据癫痫发作特点将观察组分为抽搐组(45例)和非抽搐组(31例)、频发组(42例)和非频发组(44例),比较组间血清NSE的动态变化差异。结果:观察组出现瑞文标准推理测验(Raven’s Standard Progressive Matrices,SPM)良好、中等以及缺陷的比例明显高于对照组(χ2=29.661,P<0.01;χ2=11.304,P<0.001;χ2=9.175,P<0.0 0 2);观察组P 3 0 0波幅值明显低于对照组(t=5.8 9 9,P<0.0 1),而波潜伏期显著高于对照组(t=3.937,P<0.01)。观察组病发1 d后,其血清NSE水平达到峰值,之后逐渐下降,12 d时,基本恢复对照组水平;抽搐组发病后1和12 d的血清NSE水平明显高于非抽搐组(P<0.05),而频发组发病后1和12 d的血清NSE水平明显高于非频发组(P<0.01)。结论:PSE发作可严重损害患者的认知功能,血清NSE变化可特异性反映PSE的严重程度,可作为PSE的早期临床诊断和严重程度评估指标之一。

Objective： To investigate the cognitive impairment in patients with post-stroke epilepsy and the changes of serum neuron-specific enolase（NSE）. Methods： The clinical data of 156 stroke patients in Wuhan Red Cross Hospital and Renming Hospital of Wuhan University from May 2014 to October 2017 were retrospectively analyzed. There were 80 patients without seizures after stroke as a control group, and 76 patients with seizures after stroke were served as an observation group. Cognitive impairment was compared between the 2 groups. The patients in observation group were allocated into a convulsion group（n=45） and a non-convulsion group（n=31）, a frequency group（n=42） and a non-frequency group（n=44） according to the characteristics of seizure. The differences in the dynamic changes of serum neuron-specific enolase in the patients were compared. Results： The proportion of patients with Raven＇s Standard Progressive Matrices（SPM） in the observation group was significantly higher than that in the control group（χ^=29.661, P〈0.01; χ^=11.304, P〈0.001; χ^=9.175, P〈0.002）. The amplitude of P300 in the observation group was significantly lower than that in the control group（t=5.899, P〈0.01）, while the latency of wave in the observation group was significantly higher than that in the control group（t=3.937, P〈0.01）. In the observation group and all subgroups, the level of serum NSE peaked at 1 day after the onset of disease, and then gradually decreased. On the 12 th day, the level of NSE in the observation group was basically recovered. The levels of serum NSE in the seizure group were significantly higher than those in the non-seizure group（P〈0.05）. Serum NSE levels in patients with frequent episodes were significantly higher than those in non-frequent episodes（P〈0.01）. Conclusion： Epileptic seizures after stroke can seriously impair the cognitive function of patients. The changes in serum enolase can reflect the severity of epilepsy after stroke, provide a reference for the early clinical diagnosis, and can be an indicator of severity of epilepsy after stroke.