活化部分凝血活酶时间和D-二聚体与卒中后癫痫的相关性临床研究

Clinical Study on Correlation Between Activated Partial Thromboplastin Time and D-dimer and Post-Stroke Epilepsy

目的探讨卒中后癫痫(post-stroke epilepsy,PSE)的危险因素,以及活化部分凝血活酶时间(activated partial thromboplastin time,APTT)和D-二聚体(D dimer,DD)与PSE的相关性。方法连续收集我院2017年12月至2019年4月住院治疗的PSE患者120例为病例组,同期住院治疗的单纯急性脑卒中且在1年内随访未发生癫痫患者1920例为对照组。收集两组患者人口学资料、TOAST分型及病灶是否累及皮质、化验结果(血常规、同型半胱氨酸、血液生化及凝血指标)。采用t检验、U检验、χ^(2)检验进行单因素分析,二元Logistic模型用于多因素回归分析。结果与对照组相比,病例组在房颤病史、是否累及皮质、NIHSS评分>7分、心源性栓塞(cardiac embolism,CE)、凝血酶原时间(prothrombin time,PT)、APTT和DD存在统计学差异(P<0.05)。二元Logistic回归分析提示房颤病史(OR:12.365,95%CI:1.750~87.368,P=0.012)、累及皮质(OR:6.136,95%CI:3.261~11.545,P<0.001)、NIHSS评分>7分(OR:2.157,95%CI:1.199~3.88,P=0.010)、CE(OR:13.110,95%CI:1.576~109.066,P=0.017)、APTT缩短(OR:0.173,95%CI:0.093~0.321,P<0.001)、DD增高(OR:1.227,95%CI:1.129~333,P<0.001)为PSE的独立危险因素(P<0.05)。结论APTT和DD为PSE的独立危险因素,可能成为新的治疗靶点。

Objective To investigate the risk factors of post-stroke epilepsy(PSE),and the correlation between activated partial thromboplastin time(APTT)and D-dimer(D-dimer)and PSE.Methods A total of 120 PSE patients hospitalized in our hospital from December 2017 to April 2019 were successively collected into case group.A total of 1920 patients with simple acute stroke who were hospitalized during the same period and did not have epilepsy during 1-year follow-up were selected into control group.Demographic data,TOAST classification,cortical involvement of lesions,and laboratory results(blood routine,homocysteine,blood biochemical and coagulation indicators)were collected in both groups.T test,U test andχ^(2) test were used for univariate analysis,and Binary Logistic Model was used for multivariate regression analysis.Results Compared with the control group,there were statistically significant differences in the history of atrial fibrillation,cortical involvement,NIHSS score>7,cardiac embolism(CE),prothrombin time(PT),APTT and DD in the case group(P<0.05).Binary Logistic regression analysis indicated a history of atrial fibrillation(OR:12.365,95%CI:1.750~87.368,P=0.012),cortical involvement(OR:6.136,95%CI:3.261~11.545,P<0.001),and NIHSS score>7(OR:2.157,95%CI:1.199~3.88,P=0.010),CE(OR:13.110,95%CI:1.576~109.066,P=0.017),shortened APTT(OR:0.173,95%CI:0.093~0.321,P<0.001)and increased DD(OR:1.227,95%CI:1.129~333,P<0.001)were independent risk factors for PSE(P<0.05).Conclusion APTT and DD are independent risk factors for PSE and may become new therapeutic targets.