胶质瘤患者中癫痫发作影响因素及其与痫性再发的关系

目的 分析胶质瘤患者癫痫发作的影响因素,并探讨致痫发作因素与术后痫性再发之间的关系.方法 回顾性分析郑州大学第五附属医院2012年1月-2015年12月收治的95例胶质瘤患者资料,将其分为两组,其中伴有癫痫发作组54例,无癫痫发作组41例,所有患者均行肿瘤切除术,对伴有癫痫发作者寻找癫痫病灶并作切除,术后通过电话或患者来院复查进行随访并记录痫性再发情况,术后随访时间为2012年2月-2016年12月.整理并分析患者的临床资料,探讨胶质瘤患者痫性发作的影响因素以及致痫性发作相关因素与术后痫性再发的关系,对致痫性发作相关因素采用x2检验和多因素Logistic回归模型;致痫性发作相关因素与术后痫性再发之间的关系行x2检验.结果 Logistic回归模型显示瘤周水肿带＞2 cm(OR =6.905,95％ CI:2.787 ～ 17.106)及肿瘤低病理级别(OR=5.032,95％CI:1.696～14.931)是致痫性发作的独立危险因素,通过随访发现术后有16例患者(癫痫发作组13例,无癫痫发作组3例)于不同时间出现痫性再发作,水肿带与癫痫发作组和无癫痫发作组患者术后痫性再发有关(x2依次为2.940,3.049,均P ＜0.05),病理分级与癫痫发作组术后痫性再发有关(x2=4.774,P＜0.05),而与无癫痫发作组术后痫性再发无关(x2 =0.060,P ＞0.05).术前癫痫史与术后痫性再发有关(x2=4.672,P＜0.05).结论 瘤周水肿带＞2 cm、肿瘤低病理级别是导致胶质瘤患者癫痫发作以及术后痫性再发的危险因素,积极处理相关因素,有望降低癫痫发作,尤其对伴有癫痫发作的胶质瘤患者,应格外关注.

Influencing factors of seizures in glioma patients and its relationship with recurrent epilepsy

Objective To analyze the influencing factors of epilepsy in patients with glioma,and to explore the relationship between the epileptic factors and the recurrence of epilepsy after surgery.Methods From January 2012 to December 2015,clinical data of 95 glioma patients in the Fifth Affiliated Hospital of Zhengzhou University were retrospectively analyzed,which were divided into two groups,including 54 cases with epilepsy and 41 cases without epilepsy,all patients were underwent tumor resection,to search and resect epilepsy lesions in patients with epilepsy,Follow-up using outpatient examination and telephone interview was performed to record seizure recurrence after operation,sort and analyze the clinical data of patients,to investigate the influencing factors of epileptic seizures,and the relationship between the factors associated with epileptic seizures and postoperative recurrence of epilepsy.The epileptogenic factors were analyzed using x2 test and multifactor Logistic regression model,epileptogenic factors and recurrent epilepsy after operation were analyzed usingx2 test.Results Logistic regression model showed that peritumoral edema ＞ 2 cm(OR =6.905,95％ CI:2.787-17.106),low tumor pathological grade (0R =5.032,95％ CI:1.696-14.931) were independent risk factors for epileptic seizures;Follow-up situations:16 cases (13 cases of epilepsy group,3 cases of no epilepsy group) showed epileptic seizure in different time after the operation,preoperative epilepsy history,peritumoral edema were related to the recurrence of epileptic seizures in epilepsy group and the patients without epilepsy (x2 =2.940,3.049,all P ＜ 0.05),the pathological grade was related to the recurrence of epileptic seizures in epilepsy group (x2=4.774,P ＜ 0.05),however,it was not associated with the patients without epilepsy (x2 =0.060,P ＞ 0.05),and there was a correlation between the preoperative history of epilepsy and the postoperative recurrent seizures (x2 =4.672,P ＜ 0.05).Conclusions Peritumoral edema ＞ 2 cm and low tumor pathological grade are the factors that lead to epileptic seizures and postoperation epilepsy recurrence in glioma patients.It's expected to take some positive treatment to reduce epileptic seizures,we should pay special attention to glioma patients with epilepsy.