中国脑胶质瘤患者术后发生癫痫危险因素的Meta分析

Risk Factors of Postoperative Epilepsy in Glioma Patients in China:a Meta-analysis

目的 系统评价中国脑胶质瘤患者术后发生癫痫的危险因素。方法 计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库公开发表的中国脑胶质瘤患者术后发生癫痫危险因素的文献。检索时限为建库至2023年5月。提取纳入文献的资料,病例对照研究和队列研究文献质量采用纽卡斯尔-渥太华量表(NOS)进行评价,采用RevMan 5.4软件进行Meta分析。结果 本研究纳入16篇文献,共3 612例患者,其中癫痫组592例、对照组3 020例。Meta分析结果显示,术前癫痫发作频率≥1次/d[OR=2.78,95%CI(1.84~4.91)]、有癫痫病史[OR=5.42,95%CI(4.23~6.93)]、术前有运动障碍[OR=5.56,95%CI(3.31~9.33)]、术前未预防用药[OR=6.75,95%CI(3.11~14.65)]、额颞叶肿瘤[OR=2.39,95%CI(1.41~4.05)]、低级别脑胶质瘤[OR=5.24,95%CI(3.27~8.39)]、肿瘤直径≥5 cm[OR=5.20,95%CI(2.32~11.66)]、部分切除[OR=8.76,95%CI(3.57~21.46)]、术后瘤周水肿[OR=2.96,95%CI(1.45~6.03)]、术后瘤周水肿≥2 cm[OR=4.85,95%CI(2.45~9.57)]、术后瘤腔出血[OR=3.30,95%CI(1.82~5.99)]、术后未预防用药[OR=8.36,95%CI(3.30~21.18)]、肿瘤复发[OR=4.02,95%CI(2.31~6.98)]是中国脑胶质瘤患者术后发生癫痫的危险因素(P<0.05)。结论 现有证据显示,术前癫痫发作频率≥1次/d、有癫痫病史、术前有运动障碍、术前未预防用药、额颞叶肿瘤、低级别脑胶质瘤、肿瘤直径≥5 cm、部分切除、术后瘤周水肿、术后瘤周水肿≥2 cm、术后瘤腔出血、术后未预防用药、肿瘤复发是中国脑胶质瘤患者术后发生癫痫的危险因素。

Objective To systematically evaluate the risk factors of postoperative epilepsy in glioma patients in China.Methods Databases including the PubMed,Web of Science,Cochrane Library,Embase,CNKI,Wanfang Data,VIP,CBM were retrieved to search for studies on the risk factors of postoperative epilepsy in glioma patients in China from inception to May 2023.The data of the included literature were extracted,the Newcastle-Ottawa Scale was used to evaluate the quality of the case-control studies and cohort studies.RevMan 5.4 was used for meta-analysis.Results A total of 16 articles were included,and involving 3612 patients,including 592 cases in epilepsy group and 3020 cases in control group.Meta-analysis results showed that frequency of preoperative epilepsy≥1 time/day[OR=2.78,95%CI(1.84-4.91)],history of epilepsy[OR=5.42,95%CI(4.23-6.93)],preoperative dyskinesia[OR=5.56,95%CI(3.31-9.33)],unperotected medication before surgery[OR=6.75,95%CI(3.11-14.65)],frontal and temporal lobe tumors[OR=2.39,95%CI(1.41-4.05)],low-grade glioma[OR=5.24,95%CI(3.27-8.39)],tumor diameter≥5 cm[OR=5.20,95%CI(2.32-11.66)],partial resection[OR=8.76,95%CI(3.57-21.46)],postoperative peritumoral edema[OR=2.96,95%CI(1.45-6.03)],postoperative peritumoral edema≥2 cm[OR=4.85,95%CI(2.45-9.57)],postoperative intratumoral hemorrhage[OR=3.30,95%CI(1.82-5.99)],unprotected medication after surgery[OR=8.36,95%CI(3.30-21.18)],tumor recurrence[OR=4.02,95%CI(2.31-6.98)]were the risk factors of postoperative epilepsy in glioma patients in China(P<0.05).Conclusion The available evidence shows that the frequency of preoperative epilepsy≥1 time/day,history of epilepsy,preoperative dyskinesia,unperotected medication before surgery,frontal and temporal lobe tumors,low-grade glioma,tumor diameter≥5 cm,partial resection,postoperative peritumoral edema,postoperative peritumoral edema≥2 cm,postoperative intratumoral hemorrhage,unprotected medication after surgery,tumor recurrence are the risk factors of epilepsy in glioma patients in China.