血管性痴呆患者继发癫痫的危险因素研究

Risk factors for secondary epilepsy in vascular dementia patients

目的观察血管性痴呆(vascular dementia,VaD)患者继发癫痫风险的危险因素。方法回顾性选择2016年6月~2018年6月北京市海淀医院神经内科收治的VaD患者210例,根据是否继发癫痫分为单纯VaD组120例和继发癫痫组90例。统计患者一般资料,神经功能缺损采用美国国立卫生研究院卒中量表(NIHSS)评分,行经颅多普勒超声检查,测定大脑中动脉屏气前平均血流速度(Vm)、屏气末平均血流速度(Vm’)、搏动指数(PI)、阻力指数(RI)和屏气指数(BHI)。采用多因素logistic回归分析VaD患者继发癫痫的独立危险因素。结果单纯VaD组皮质病灶和病灶面积≤15mm比例明显高于继发癫痫组,差异有统计学意义(77.5%vs 46.7%,64.2%vs55.6%,P<0.01),NIHSS评分明显低于继发癫痫组[(10.20±3.55)分vs(12.33±3.85)分,P<0.01]。单纯VaD组Vm、Vm’和BHI明显高于继发癫痫组,PI和RI明显低于继发癫痫组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,病灶部位、病灶面积、NIHSS评分、Vm和Vm’是VaD患者继发癫痫的独立危险因素(P<0.05,P<0.01)。结论皮质下病灶、病灶面积过大、NIHSS评分过高、Vm及Vm’下降是VaD继发癫痫的独立危险因素,临床应引起足够重视。

Objective To study the risk factors for secondary epilepsy in vascular dementia(VaD)patients.Methods Two hundred and ten VaD patients admitted to our hospital from June 2016 to June 2018 were divided into simple VaD group(n=120)and secondary epilepsy group(n=90).Their general clinical data were recorded.The patients underwent transcranial Doppler ultrasonography.The following parameters of middle cerebral artery before breath holding were measured,including mean blood flow velocity(Vm),mean blood flow velocity(Vm’),pulsation index(PI),resistance index(RI)and breath holding index(BHI).The independent risk factors for secondary epilepsy in VaD patients were analyzed by multivariate logistic regression analysis.Results The ratio of cortical lesions was significantly higher,the size of cortical lesions≤15 mm was significantly larger while the NIHSS score was significantly lower in simple VaD group than in secondary epilepsy group(77.5%46.7%,64.2%55.6%,10.20±3.55 vs 12.33±3.85,P<0.01).The Vm,Vm’and BHI were significantly higher while the PI and RI were significantly lower in simple VaD group than in secondary epilepsy group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that the location and size of cortical lesions,NIHSS score,Vm and Vm’were the independent risk factors for secondary epilepsy in VaD patients(P<0.05,P<0.01).Conclusion Cortical lesions,large size of cortical lesions,high NIHSS score,low Vm and Vm’are the independent risk factors for secondary epilepsy in VaD patients,to which attention should be paid in clinical practice.