动脉瘤蛛网膜下腔出血后癫痫惊厥性发作与全身炎症性反应的相关性

Correlation of convulsive seizures after aneurysmal subarachnoid hemorrhage with systemic inflammatory response syndrome

目的探索并评估动脉瘤蛛网膜下腔出血(aSAH)后出现癫痫惊厥性发作与全身炎症反应综合征(SIRS)的相关性。方法回顾性分析了2011年6月至2018年6月期间于浙江大学医学院附属第一医院就诊的502例符合纳入标准的aSAH患者,通过单因素分析和多因素分析确定SIRS发生的危险因素。将SIRS根据不同时间不同意义定义为早期全身炎症反应综合征(early SIRS),迟发型全身炎症反应综合征(delayed SIRS),全身炎症反应综合征负荷(SIRS burden),早期全身炎症反应综合征负荷(early SIRS burden,ESB);迟发型全身炎症反应综合征负荷(delayed SIRS burden,DSB),再探索与癫痫惊厥性发作的关系。结果aSAH患者中有75.7%的患者出现early SIRS,78%的患者出现delayed SIRS。出现癫痫惊厥性发作的患者的SIRS burden中位数为80%(四分位数,60%~100%),癫痫惊厥性发作没有出现的患者的SIRS burden中位数为50%(四分位数,20%~80%)。世界神经外科医生联盟SAH分级(WFNS grade)和改良FISHER分级(Modifed Fisher Scale score)这两个指标被证明是early SIRS和delayed SIRS的相关危险因素。进一步的多因素分析,发现delayed SIRS(OR=8.950;95%CI=1.195~67.100),SIRS burden(OR=15.480;95%CI=3.530~67.180),ESB(OR=4.125;95%CI=1.370~12.360)和DSB(OR=9.780;95%CI=2.720~35.210)都与癫痫惊厥性发作有显著相关。SIRS burden对于癫痫惊厥性发作的预测值(ROC曲线面积,AUC=0.710;95%CI=0.620~0.800)是最显著的。结论研究证明delayed SIRS,SIRS burden,ESB和DSB都与aSAH后癫痫惊厥性发作有关。癫痫的发生还与持续的SIRS相关。

Objective To explore the correlation of convulsive seizures after aneurysmal subarachnoid hemorrhage(aSAH)with systemic inflammatory response syndrome(SIRS).Methods A retrospective analysis of 502 patients with aSAH in the first affiliated hospital of Zhejiang university school of medicine from June 2011 to June 2018 was conducted.Univariate and multivariate analyses were used to identify the risk factors for SIRS development,Early SIRS,delayed SIRS,SIRS burden,early SIRS burden(ESB)and delayed SIRS burden(DSB)were identified according to different times and different meanings.The correlation between SIRS and convulsive seizures was explored.Results 75.7%of aSAH patients had early SIRS,and 78%developed delayed SIRS.Median SIRS burden was 80%(interquartile range,60%-100%)in patients with convulsive seizures,and 50%(interquartile range,20%-80%)in patients without seizures.World federation of neurosurgical societies(WFNS)admission grade and modified Fisher scale score were found to be risk factors for both early SIRS and delayed SIRS.In multivariate analysis,delayed SIRS(OR=8.950;95%CI=1.195-67.100),SIRS burden(OR=15.480;95%CI=3.530-67.180),ESB(OR=4.125;95%CI=1.370-12.360)and DSB(OR=9.780;95%CI=2.720-35.210)were significantly associated with convulsive seizures.SIRS burden[area under the curve(AUC)=0.710;95%CI=0.620-0.800]had a higher predictive value for convulsive seizures compared with other SIRS criteria.Conclusion Delayed SIRS,SIRS burden,ESB and DSB are associated with post-aSAH convulsive seizures.Convulsive seizures onset is related to sustained SIRs.