热性惊厥复发及左乙拉西坦间歇短程预防的临床研究

Clinical study on recurrence of febrile seizures and intermittent short-term prophylactic levetiracetam therapy

目的分析热性惊厥(febrile seizures,FS)复发的临床特征,观察左乙拉西坦(levetiracetam,LEV)预防FS复发的效果。方法回顾性分析2017年5月至2020年5月我院神经内科收治的101例FS复发病例的临床资料,了解FS复发情况及LEV应用过程可能的不良反应。采用Cox比例风险模型回归分析FS复发与LEV预防的关系。结果101例FS复发病例中以18~60月龄为主(62.4%,63/101),其中18~36月龄(39.6%,40/101)为复发高峰;FS复发均发生于发热24 h内,74.3%(75/101)发生于发热3 h内;39.6%病例(40/101)为非高热惊厥,其中30.0%(12/40)发作时温度≤38℃。95例FS纳入回顾性队列研究,应用LEV预防38例(4例失访),未预防57例(7例失访),预防组复发率为17.6%(6/34),对照组为44.0%(22/50),预防组复发率低于对照组(χ^(2)=6.325,P=0.012)。Cox回归分析复发各因素关系,提示药物预防(OR=0.325,95%CI 0.129-0.821)及FS家族史(OR=3.060,95%CI 1.427-6.560)影响FS复发。按有无FS家族史分层,显示在有/无FS家族史两层中药物预防均减少FS复发(OR=0.316,95%CI 0.124-0.802)。结论FS患儿18月龄后复发风险增大,发热早期及低热时占比多;药物预防FS复发,应注意高发月龄,及早、低热应用;使用LEV预防FS复发有效,不良反应轻微。

Objective To analyze the clinical features of the recurrence of febrile seizures(FS),and observe the efficacy of levetiracetam(LEV)in preventing FS recurrence.Methods We retrospectively analyzed the clinical data of 101 cases of FS recurrence who were admitted to the Department of Neurology of our hospital from May 2017 to May 2020,and collected the information of the recurrence after discharge and adverse effects of LEV application.Cox proportional hazards model regression was applied to explore the relationship between FS recurrence and LEV prophylaxis.Results Among 101 cases of recurrent FS,the section of 18-60 months(63/101)composed the dominant proportion,of which the episode of 18-36 months(40/101)took the biggest recurrence rate.All 101 recurrent FS cases occurred within 24 hours of fever-beginning time,and 74.3%(75/101)occurred within 3 hours of fever onset.39.6%cases(40/101)were non-high febrile seizures,of which 30.0%(12/40)even had a temperature≤38°C at the onset.Ninty-five cases of FS were included in the retrospective cohort study.Thirty-eight cases(4 lost to follow-up)were treated with LEV,while 57 cases(7 lost to follow-up)were not treated with any anticonvulsant drugs.The recurrence rate in the prophylactic group was 17.6%(6/34),compared with 44.0%(22/50)in the control group.The recurrence rate of the prophylactic group was statistically lower than that of the control group(χ^(2)=6.325,P=0.012).Cox regression analysis was used to explore the relationship between FS recurrence and various factors,suggesting LEV prophylaxis(OR=0.325,95%CI 0.129-0.821) and family history of FS (OR=3.060,95%CI 1.427-6.560) affect the recurrence of FS.Then FS family history was stratified,LEV prophylaxis still statistically reduced the recurrence of FS (OR=0.316,95%CI 0.124-0.802).Conclusion The risk of recurrence increases significantly after 18 months of the age.Besides,FS recurrence is relatively common in the initial episode of fever and in the stage of low fever.For children at months of high probability of recurrence,prophylactic drugs should be used in the initial episode of fever and in the stage of low fever.LEV prophylaxis therapy is effective,with mild adverse reactions.