蛛网膜下腔出血继发症状性癫痫的发生率、危险因素及院内结局：来自中国卒中联盟登记数据库的分析 Incidence, Risk Factors and In-hospital Outcomes of Symptomatic Seizures after Subarachnoid Hemorrhage:Analysis from China Stroke Center Alliance Registry Database

Abstract

目的 调查蛛网膜下腔出血（subarachnoid hemorrhage，SAH）患者继发症状性癫痫的发生率、相关危险因素及其与院内结局的关系。 方法 本研究数据来源于中国卒中联盟（China Stoke Center Alliance，CSCA）登记数据库2015年8月1日-2019年7月31日入组的SAH患者。症状性癫痫限定为住院期间发作。依据是否出现继发症状性癫痫，将研究对象分为SAH继发癫痫组和无继发癫痫组，比较组间的人口学特征、入院GCS评分、血管危险因素、手术以及医院级别和地区的差异。采用多因素Logistic回归，分析SAH继发癫痫的危险因素，以及SAH继发癫痫与院内死亡、缺血性卒中、脑出血及肺炎的相关性。 结果 本研究纳入11 210例SAH患者，女性6623例（59.1%），平均年龄60.0±12.9岁，入院GCS评分的中位数为15分。总计228例（2.0%）继发症状性癫痫。年龄（OR 0.92，95%CI 0.87～0.97）、既往卒中/TIA（OR 1.61，95%CI 1.20～2.17）、颈动脉狭窄（OR 3.17，95%CI 1.27～10.85）、心房颤动（OR 2.64，95%CI 1.12～6.24）、脂代谢紊乱（OR 1.79，95%CI 1.03～3.13）和脑室外分流术（OR 2.30，95%CI 1.31～4.02）是SAH继发症状性癫痫的独立影响因素。SAH继发症状性癫痫可能与更高的院内死亡（OR 1.71，95%CI 0.96～3.05）、缺血性卒中（OR 4.21，95%CI 2.70～6.56）、脑出血（OR 3.87，95%CI 2.81～5.33）及肺炎（OR 2.96，95%CI 2.26～3.86）事件风险相关。 结论 症状性癫痫是SAH患者较为常见的神经系统并发症，低龄、既往卒中/TIA、颈动脉狭窄、心房颤动、脂代谢紊乱以及脑室外分流术是SAH继发症状性癫痫的独立危险因素。SAH继发症状性癫痫增加院内死亡、缺血性卒中、脑出血以及肺炎的风险。 【Abstract】 Objective To investigate the incidence and risk factors of symptomatic seizures after subarachnoid hemorrhage (SAH), and the relationship between secondary seizures and in-hospital outcomes. Methods The in-hospital SAH patients from the China Stoke Center Alliance (CSCA) registry database from August 1, 2015, to July 31, 2019 were enrolled in the retrospective analysis. According to the presence of symptomatic seizures or not after SAH during hospitalization, all the subjects were divided into SAH with seizure group and SAH without seizure group. Differences in demographics, score of Glasgow comma scale (GCS) at admission, vascular risk factors, surgery, and the class and region of hospitals were compared. A multivariate logistic regression model was used to identify risk factors of seizures after SAH and evaluate the association of in-hospital death, ischemic stroke, intracerebral hemorrhage (ICH) and pneumonia with symptomatic seizures after SAH. Results A total of 11 210 SAH patients were enrolled in this study, with the average age of 60.0±12.9 years and 6623 (59.1%) females, and the median GCS score was 15 points. A total of 228 (2.0%) cases had symptomatic seizures after SAH. Age (OR 0.92, 95%CI 0.87-0.97), prior stroke/TIA (OR 1.61, 95%CI 1.20-2.17), carotid stenosis (OR 3.17, 95%CI 1.27-10.85), atrial fibrillation (OR 2.64, 95%CI 1.12-6.24), dyslipidemia (OR 1.79, 95%CI 1.03-3.13), and external ventricular drainage (OR 2.30, 95%CI 1.31-4.02) were independent risk factors for symptomatic seizures after SAH. Symptomatic seizures after SAH may be associated with a higher risk of in-hospital death (OR1.71, 95%CI 0.96-3.05), ischemic stroke (OR 4.21, 95%CI 2.70-6.56), ICH (OR 3.87, 95%CI 2.81-5.33) and pneumonia (OR 2.96, 95%CI 2.26-3.86). Conclusions Symptomatic seizures is a common neurological complication in SAH patients. Younger age, prior stroke/TIA, carotid stenosis, atrial fibrillation, dyslipidemia and external ventricular drainages were independent risk factors for symptomatic seizures after SAH. Symptomatic seizures after SAH increased the risk of in-hospital death, cerebral infarction, ICH pneumonia