非瓣膜心房纤颤相关性脑卒中患者早发性癫痫发作的发生率以及危险因素分析

目的探讨非瓣膜心房纤颤(房颤)相关性脑卒中患者早发性癫痫发作的发生率以及危险因素。方法对2008~2015年陕西省14家三级医院的病例资料进行多中心性、回顾性研究。依据卒中后1周是否出现癫痫发作,将患者分为早发性癫痫发作组和对照组,通过单因素和多因素Logistic回归分析筛选出影响非瓣膜房颤相关性脑卒中患者早发性癫痫发作的危险因素。结果共纳入1077例非瓣膜房颤相关性脑卒中病例,男540例,女537例,年龄34~94岁,中位数73岁。发生卒中后早发性癫痫发作共21例(1.95%)。多因素Logistic回归显示两组NIHSS评分(95%CI:1.642~9.701,P=0.002)、既往脑卒中病史(95%CI:2.631~15.593,P0.01)差异有统计学意义。ROC曲线分析显示,曲线下面积为0.762,灵敏度61.9%,特异度81.0%,预测准确率71.5%。结论严重的卒中神经功能缺损、既往脑卒中病史是非瓣膜房颤相关性脑卒中患者早发性癫痫发作的重要危险因素。

Analysis of the incidence rate and risk factors of early epileptic seizures in the patients with nonvalvular atrial fibrillation-related stroke

Objective To investigate the incidence rate and risk factors of early epileptic seizures in patients with nonvalvular atrial fibrillation-related stroke .Methods A retrospective and multi-center clinical study was performed in 14 tertiary hospitals of shanxi province from 2008 to 2015.Patients were divided into early epileptic seizures group and control group according to whether there was a seizure in one week after stroke .Risk factors for early epileptic seizures in patients with nonvalvular atrial fibrillation-related stroke were screened by single factor analysis and Logistic regression analysis .Results One thousand and seventy-seven eligible patients were enrolled in the study, of whom men were 540 and women were 537.The median age was 73 years old with interquartile ranges from 34 to 94.Twenty-one patients(1.95%) had poststroke early epileptic seizures .Multivariate Logistic regression showed that the NIHSS score (95%CI: 1.642 -9.701, P=0.002) and history of stroke (95%CI: 2.631 -15.593,P<0.01 ) had statistical significances between two groups .The area under the ROC was 0.762, with sensitivity 61.9%, specificity 81.0% and predictive accuracy 71.5%.Conclusion Severe stroke neurological deficits and history of stroke are important risk factors for early epileptic seizures in nonvalvular atrial fibrillation -related stroke patients .