中国西部地区成人癫痫共患病现状及影响因素

Present situation and risk factors of comorbidity in adult epilepsy patients in West China

目的研究中国西部地区成年人癫痫常见共患病现状,分析其相关危险因素。方法收集2017年4月-2018年3月就诊于四川省人民医院神经内科癫痫中心的199例癫痫患者,采用中文版广泛焦虑量表、癫痫抑郁量表、匹兹堡睡眠质量指数量表和Epworth嗜睡量表等进行评估。采用Logistic回归分析癫痫共患病的相关危险因素。结果 199例成人癫痫患者中28.1%共患焦虑,17.1%共患抑郁,33.2%共患睡眠障碍,2.5%共患偏头痛。140例患者单药治疗,包括卡马西平(CBZ)15例、拉莫三嗪(LTG)20例、左乙拉西坦(LEV)26例、托吡酯(TPM)31例、奥卡西平(OXC)25例、丙戊酸钠(VPA)23例。单药治疗的癫痫患者Logistic回归分析显示:发作频率≥1次/月、LEV、TPM、睡眠障碍是癫痫共患焦虑的独立危险因素(P<0.05);无业、近3个月有临床发作、睡眠障碍是共患抑郁的独立危险因素(P<0.05);焦虑、抑郁、白天嗜睡、CBZ、LTG是共患睡眠障碍的独立危险因素(P<0.05)。结论焦虑、抑郁、睡眠障碍是中国西部地区成人癫痫患者常见的共患病。对存在情感障碍及睡眠障碍的患者,早期识别和积极干预癫痫共患病,对改善患者生活质量及预后可能具有重要意义。LEV、TPM单药治疗的患者发生焦虑的风险高于其他药物,LTG、CBZ单药治疗的患者更容易共患睡眠障碍。

Objective To explore the status of common comorbidities in adult epilepsy patients in western China,and to explore the related risk factors.Methods The Chinese version of Generalized Anxiety Disorder(GAD)-7,neurological disorders depression inventory for epilepsy(NDDI-E)scales,Pittsburgh sleep quality index scale(PSQI)and epworth sleepiness scale(ESS)were used to evaluate the 199 epilepsy patients between April 2017 and March 2018 in the Epilepsy Center of Neurology Department of Sichuan People’s Hospital.Logistic regression analysis was performed on the risk factors of epilepsy comorbidity.Results In the 199 adult epilepsy patients,28.1%had anxiety,17.1%had depression,33.2%had sleep disorder,and 2.5%had migraine.140 patients received monotherapy,including 15 patients with carbamazepine(CBZ),20 patients with lamotrigine(LTG),26 patients with levetiracetam(LEV),31 patients with topiramate(TPM),25 patients with oxcarbazepine(OXC),and 23 patients with Valproate(VPA).Multivariate logistic regression analysis of epilepsy patients treated with monotherapy showed that seizure occurring more than once a month,LEV,TPM,sleep disorders were independent risk factors for anxiety in patients with epilepsy(P<0.05).Unemployment,seizure occurrence in the last three months,sleep disorders were independent risk factors for comorbid depression(P<0.05).Anxiety,depression,daytime sleepiness,CBZ,LTG were independent risk factors for comorbid sleep disorders(P<0.05).Conclusions Anxiety,depression and sleep disorder are common comorbidities in adults with epilepsy in westChina.For patients with affective disorder and sleep disorder,early identification and intervention may be important to improve the quality of life and prognosis of patients.In addition,patients treated with LEV or TPM monotherapy had a higher risk of anxiety than other drugs.Patients with LTG and CBZ monotherapy are more likely to comorbid sleep disorders.