儿童脑损伤病因与癫痫关系的临床研究

Study on the relationship between the etiology of brain injury and epilepsy in children

目的探讨儿童脑损伤病因与癫痫的关系,为临床预防、早期干预儿童脑损伤提供理论依据。方法回顾性分析郑州大学第三附属医院2013-01—2017-12治疗的1194例癫痫患儿及同期1194例非癫痫患儿的临床资料,探讨脑损伤病因与其发生癫痫的关系。结果1194例癫痫患儿中遗传性病因58例(4.9%),结构性病因449例(37.6%),代谢性病因22例(1.8%),感染性病因42例(3.5%),免疫性病因28例(2.4%),病因未明者595例(49.8%)。具体病因包括早产、新生儿低血糖、新生儿缺氧缺血性脑病(hypoxia-ischemic encephalopathy,HIE)、颅内出血、足月小样儿、新生儿高胆红素血症、先天性脑发育不良、遗传代谢病、新生儿重症感染、中枢神经系统感染、自身免疫性脑炎(autoimmune encephalitis,AE);其中癫痫的发生与新生儿HIE、早产、先天性脑发育不良、新生儿低血糖、中枢神经系统感染、AE均有关,且新生儿HIE、早产、新生儿低血糖是癫痫发生的独立危险因素。结论儿童脑损伤病因与癫痫的发生相关,尤其新生儿HIE、早产、新生儿低血糖。临床医师应重视围生期保健,降低脑损伤发病率,早期干预脑损伤,对于降低癫痫的发病率具有重要的临床意义。

Objective To explore the relationship between the etiology of children's brain injury and the occurrence of epilepsy,and provide theoretical basis for clinical prevention and early intervention of children's brain injury.Methods The clinical data of 1194 children with epilepsy hospitalized in the Department of Pediatric Neurology from January 2013 to December 2017 in the Third Affiliated Hospital of Zhengzhou University and 1194 children with non-epilepsy who were hospitalized in the Pediatric Department of our hospital during the same period were analyzed retrospectively.Results The results showed that among the 1194 children with epilepsy,58(4.9%)were caused by genetic etiology,449(37.6%)by structural etiology,22(1.8%)by metabolic etiology,42(3.5%)by infection etiology,28(2.4%)by immune etiology,and 595(49.8%)by unknown etiology.Specific causes includepreterm delivery,neonatal hypoglycemia,neonatal hypoxic-ischemic encephalopathy(HIE),intracranial hemorrhage,small for gestational age,neonatal hyperbilirubinemia,congenital brain dysplasia,genetic metabolic diseases,neonatal severe infection,central nervous system infection and autoimmune encephalitis(AE).Among them,the occurrence of epilepsy is related to neonatal HIE,preterm birth,congenital brain dysplasia,neonatal hypoglycemia,central nervous system infection and AE,and neonatal HIE,preterm birth and neonatal hypoglycemia are independent risk factors for the occurrence of epilepsy.Conclusion The etiology of brain injury in children is related to epilepsy,especially HIE,preterm delivery and neonatal hypoglycemia.Therefore,clinicians should pay attention to perinatal health care,for reducing the incidence of brain injury.Moreover,early intervention of brain injury has important clinical significance for reducing the incidence of epilepsy.