癫痫共病焦虑抑郁的相关因素与脑电背景活动非线性特征

Analysis of related factors of epilepsy comorbidity anxiety and depression and research on the nonlinear characteristics of EEG background activities

目的探讨癫痫共病焦虑抑郁的患病率及危险因素,并研究癫痫共病焦虑抑郁患者与不共病焦虑抑郁患者的脑电背景活动在非线性特征上的差异。方法采用SAS/SDS自评量表对2018年1月至2019年6月门诊癫痫患者的焦虑、抑郁症状进行评估,收集患者临床特征,采用多因素logistic回归分析对危险因素进行评估。同时随机筛选55例癫痫共病焦虑抑郁患者的脑电图数据作为病例组,与不共病焦虑抑郁患者的脑电图数据进行比较,将每个患者的脑电图数据生成非线性参数Hurst指数,分析组间各导联Hurst指数差异,采用ROC曲线评估分形分析对癫痫共病焦虑抑郁的诊断效能。结果本研究共纳入450例癫痫患者,40.2%存在抑郁症状,25.6%存在焦虑症状,21.8%同时存在抑郁和焦虑。文化程度越低、癫痫发作越频繁则癫痫共病焦虑或抑郁的可能性越大;用药种类越多,癫痫共病抑郁的风险越高。文化程度是癫痫共病焦虑的独立危险因素,文化程度、发作频率是癫痫共病抑郁的独立危险因素。脑电背景活动非线性特征研究结果显示:导联T5-Fz、T5-T6、C4-Cz的Hurst指数在两组间的差异具有统计学意义,而T5-T6、T5-Fz导联对癫痫共病焦虑抑郁有中等程度的诊断效能。结论癫痫患者普遍存在焦虑和抑郁症状,抑郁比焦虑更常见。文化程度低、发作频繁的癫痫患者表现出了更高的焦虑、抑郁患病率。利用脑电信号的非线性参数可以识别癫痫共病焦虑抑郁患者,T5-Fz、T5-T6导联有望成为识别癫痫共病焦虑抑郁的有效工具。

Objective To investigate the prevalence rate and risk factors of epilepsy comorbid anxiety and depression,and to study the difference in non-linear characteristics of EEG background activities between epilepsy comorbid anxiety and depression patients and non-comorbid anxiety and depression patients.Methods SAS/SDS self-rating scale was used to evaluate the anxiety and depression symptoms of outpatients with epilepsy from January 2018 to June 2019.The clinical characteristics of patients were collected,and the risk factors were evaluated by multivariate logistic regression analysis.At the same time,the EEG data of 55 patients with comorbidity anxiety and depression were randomly selected as the case group,and compared with those of patients with non-comorbid anxiety and depression.The nonlinear Hurst index was generated from the EEG data of each patient,and the difference of Hurst index in each lead between groups was analyzed.The diagnostic efficiency of fractal analysis for comorbidity anxiety and depression was evaluated by ROC curve.Results Among 450 epileptic patients in this study,181(40.2%)had depressive symptoms,115(25.6%)had anxiety symptoms,and 98(21.8%)had both depression and anxiety.The lower the education level and the more frequent seizures,the greater the possibility of anxiety or depression caused by epilepsy.The more medicines taken,the higher the risk of depression caused by epilepsy.Education level was an independent risk factor for anxiety of epilepsy comorbidity,and education level and attack frequency were independent risk factors for depression of epilepsy comorbidity.The non-linear characteristics of EEG background activity showed that the Hurst index of leads T5-Fz,T5-T6 and C4-Cz were statistically different between the two groups,while leads T5-T6 and T5-Fz had moderate diagnostic efficacy for anxiety and depression of epilepsy comorbidity.Conclusions Anxiety and depression are common in epilepsy patients,especially depression.Epilepsy patients with low education level and frequent seizures show higher prevalence of anxiety and depression.Patients with epilepsy comorbid anxiety and depression can be identified by using the nonlinear parameters of EEG,and leads T5-Fz and T5-T6 are expected to be effective tools to identify epilepsy comorbid anxiety and depression.