脑卒中后癫痫发作的相关危险因素分析

目的 分析脑卒中后癫痫发作的临床特点,并对其相关因素进行分析。方法 对1 008例脑卒中患者进行回顾性研究,并分析可能影响卒中后继发癫痫发作的相关危险因素。结果 脑卒中后癫痫发作的发生率约为5.36%,其中早发型癫痫占63.11%,发作类型以单纯部分发作为主,迟发型癫痫占38.89%,发作类型以全身强直-阵挛发作为主,单因素分析结果显示:性别（χ2=4.12,P=0.042）、糖尿病（χ2=4.89,P=0.027）、肺部感染（χ2=8.95,P=0.003）、病灶部位（χ2=45.14,P<0.001）和病灶范围（χ2=23.32,P<0.001）与卒中后癫痫发作有关;多元Logistic分析结果显示:性别（OR=1.946,95%CI:1.039~3.644）、肺部感染（OR=3.618,95%CI:1.536~8.520）、病灶部位（OR=6.435,95%CI:3.353~12.349）和病灶范围（OR=2.513,95%CI:1.374~4.599）等因素可能与卒中后癫痫发作有关（均有P<0.05）。结论 男性,肺部有感染,病灶部位在皮质和病灶范围大可能是卒中后癫痫发作的危险因素。     

脑出血后早发性癫痫发作的危险因素探讨

目的探讨脑出血后早发性癫痫发作的危险因素。方法对我院2008年1月-2009年12月收治的285例脑出血患者的临床资料进行回顾性分析,对影响脑出血后早发性癫痫发作的相关临床因素进行单因素分析和Logistic回归分析。结果 285例患者中,脑出血后早发性癫痫发作的患者27例,发生率为9.47%。单因素分析结果显示,患者高血压病史、出血部位、血钠浓度、临床神经功能缺损程度评分及出血量与脑出血后早发性癫痫发作相关（P〈0.05）。Logistic回归分析结果显示,患者高血压病史（OR=2.958）、出血部位（OR=4.835）、临床神经功能缺损程度评分（OR=3.073）是脑出血后早发性癫痫发作的危险因素。结论有高血压病史、皮质出血和临床神经功能缺损程度评分较高的患者,其脑出血后早发性癫痫发作的危险性较高。     

人群癫痫危险因素及社会心理因素病例对照研究

目的：了解自然人群癫痫患者的危险因素及社会心理状况。方法：对上海市金山区朱泾镇普查出的71例原发性癫痫患者1：1配对进行危险因素调查及对包括10例继发性在内的癫痫患者进行配对的社会心理状况的问卷调查。结果：经过多因素逐步条件logistic回归分析发现，新生儿疾病（OR=6.517）、饮酒（OR=10.761）、癫痫家族史（OR=5.414）与癫痫有着很强的关联。病例组的社会心理状况与正常对照组存在着明显的差异，在≥17岁的成人患者中尤其明显。结论：新生儿疾病及产伤、饮酒、癫痫家族史是癫痫发病的危险因素，心理与精神异常在癫痫患者中发生率很高。     

癫痫持续状态相关因素的临床研究

目的：探讨癫痫持续状态发病的相关危险因素,为癫痫持续状态的治疗提供参考。方法回顾性分析2013年1月至2015年1月滨州医学院附属医院神经内科住院治疗的癫痫持续状态患者,共纳入72例,收集患者的临床资料。对所有患者进行随访,采用格拉斯哥预后评分评价患者预后情况,分析与预后相关的危险因素。结果患者男女性别之比为4.54：1,男性发病率显著高于女性（X2=43.581,P＜0.01）;儿童占29.17%,成人占70.83%,成人的发病率显著高于儿童（X2=42.335,P＜0.01）;CSE63例,NCSE9例,CSE的发病率显著高于NCSE,差异有统计学意义（X2=46.611,P＜0.01）;颅脑损伤、病毒性脑炎急性期和脑血管病变是癫痫持续状态发病的危险因素。结论癫痫持续状态在各年龄段均可见,成人发病率高于儿童,男性高于女性,颅脑损伤、病毒性脑炎急性期和脑血管病变是癫痫持续状态发病的危险因素。     

癫痫危险因素病例对照研究

目的 探讨癫痫发病的危险因素,为癫痫的治疗和控制提供科学依据.方法 以2008年9月-2009年8月在医院就诊的443例癫痫患者为病例组,选择同期住院的334例非癫痫患者为对照组,进行相关因素流行病学调查和统计学分析.结果 调查的23项相关因素中有8项单因素分析差异有统计学意义,6项多因素分析差异有统计学意义;其中癫痫家族史(OR=10.16,P=0.000 4),热性惊厥(OR=6.34,P=0.000 2),产伤(OR=5.38,P=0.025 7),颅脑损伤(OR=3.29,P=0.000 3)是癫痫发病的危险因素,而年龄(OR=0.62,P<0.000 1),顺产(OR=0.21,P<0.000 1)为其保护因素.结论 癫痫家族史、热性惊厥、产伤、颅脑损伤是癫痫发病的危险因素,为今后进行癫痫基因定位及其预警模型的研究提供了基础依据.     

病毒性脑炎继发癫痫患者临床特点及影响因素分析

目的：探讨病毒性脑炎继发性癫痫患者的临床特点,以提高对该病的认识。方法回顾性分析46例病毒性脑炎继发癫痫患者的临床资料。结果：46例病毒性脑炎继发癫痫患者中37例出现影像学异常,异常率为80％。癫痫发作类型：全身性强直一阵挛发作19例（41．3％）、单纯部分性发作6例（13．04％）、复杂部分性发作7例（15．22％）、部分性发作继发全面性8例（17．39％）、持续状态6例（13．04％）。脑电图表现：呈边缘脑电图4例（8．7％）、轻度异常8例（17．39％）、中度异常20例（43．48％）、重度异常14例（30．43％）、首次脑电图检测出现癫痫波（尖波、棘波、棘一慢波综合）14例（30．43％）。结论：病毒性脑炎易继发癫痫,MRI提示额、颞叶、皮层、海马等部位受累以及EEG提示中、重度异常与癫痫明确相关。     

脑梗死继发癫痫56例临床分析

目的：探讨脑梗死后继发癫痫的临床特征及其发病机理。方法；对652例住院确诊的首次脑梗死患者的临床资料进行分析与随访。结果：652例脑梗死患者中继发癫痫56例（8.59％），其中2周内发生率为26例（46.43％），2周后发生率为30例（53.57％）。脑梗死后癫痫发生在脑叶梗死者占82.1%，以颞叶最多，可见其与病灶部位密切相关。单纯部分性发作29例（51.8％）。结论：脑梗死后癫痫发作与皮层梗死密切相关，以部分性发作为多见，大面积脑梗死易继发癫痫持续状态，死亡率高。癫痫发生的机理，多与动脉硬化有关。     

癫痫综合症被误诊为病毒性脑炎的临床研究

目的：研究临床上癫痫综合症被错误诊断为病毒性脑炎的原因,为临床诊断癫痫综合症提供参考。方法：研究我院收治的的3例癫痫综合症被错误诊断为病毒性脑炎患者的临床资料。结果：3例患者中,在癫痫首次发作时,就有自主神经发作持续的状态出现,其中,1例患者无热抽搐,2例患者出现抽搐后发热状态,2例患者腰穿查生化常态、脑脊液常规,1例患者未进行腰椎穿刺检查,首次诊断后均误诊为病毒性脑炎。结论：对于长时间出现自主神经性发作的患者,应该仔细询问其病史,对其发作症状进行认真观察,以免出现误诊情况。     

全身惊厥性癫痫持续状态的救治与护理分析

目的：针对GCSE（全身惊厥性癫痫持续状态）的救治工作进行探析,并总结合理的护理模式。方法：选取我院2012年2月至2013年6月期间收治的22例GCSE患者为研究对象,对治疗措施与护理模式进行回顾性分析。结果：通过有效的治疗与合理的护理干预后,患者在2小时内病情控制发作率为63．64％,2至4小时内病情控制发作率为18．18％,24小时后病情控制缓慢发作率为13．63％,死亡率4．55％。结论：针对GCSE的患者实施临床从速控制治疗具有显著效果,在患者发作前后进行护理干预是成功救治的关键环节。     

脑卒中后继发癫痫的临床特点

目的探讨脑卒中后继发癫痫发作的类型与部位的关系及预后。方法对527例经CT证实的脑卒中患者进行回顾性分析。结果脑卒中后继发癫痫发生率为8．7％，男性〉女性。早期发作（67．3％）较迟发性发作（32．6％）的发病率为高。发作类型以强直阵挛性发作最多（52．1％），局限性运动性发作次之（36．9％），病灶部位以脑皮质、脑叶发病率高（65．2％）。早期发作者发作次数较少的短期应用抗癫痫药物疗效较好，其癫痫发作机制，认为早期多由于脑水肿和脑代谢异常，晚期多由于癫痫灶所致。结论癫痫发作是脑卒中患者的常见症状。其病变影响皮质是重要的致痫因素。     

儿童热性惊厥复发危险因素临床分析

目的 探讨儿童热性惊厥（FS）复发的危险因素。方法 选取2008年1月至2015年8月初次诊断为FS的患儿为研究对象,回顾性收集临床资料,采用单因素分析导致FS复发的影响因素,采用非条件多因素Logistic回归分析确定导致FS复发的独立危险因素。 结果 1 261例初诊为FS的病例纳入研究,按是否复发将患儿分为复发组（n = 453）及非复发组（n = 808）,2组患儿性别构成比、原发疾病、惊厥2周后脑电图变化等比较,差异无统计学意义（P＞0.05）,单因素分析结果显示复杂性FS、年龄小、惊厥时的体温低、次数多、持续时间长、发作前发热时间短、有家族FS史、缺铁性贫血、低钠血症、生活环境差异、围生期损害等11项指标与FS复发存在相关性,差异有统计学意义（P ＜0.05）。非条件多因素Logistic回归分析结果显示发病年龄小、发作时体温低、复杂性FS、发作前发热时间≤1 h、有家族FS史、合并症(缺铁性贫血/低钠血症)是导致FS复发的独立危险因素。结论 儿童FS易复发,首发时应评估危险因素,给予适当的干预措施并密切随访。     

部分性发作癫痫患儿智力发育的影响因素分析

【目的】 分析部分性发作癫痫患儿智力发育状况,研究影响部分性发作癫痫患儿智力发育的独立影响因素。 【方法】 对根据症候学、EEG及MRI检查等检查结果诊断为部分性发作的106例癫痫患儿进行智商测定,根据智商测定结果将患儿分为智力正常组(IQ≥80)和智力异常组(IQ<80)。经单因素和多因素 Logistic回归分析确定影响部分性发作癫痫患儿智力发育的因素。 【结果】 Logistic回归分析发现:首发年龄(P=0.000,OR=6.348,95%CI:2.290~17.599),发作频率(P=0.017,OR=3.479,95%CI:1.250~9.684),MRI检查结果(P=0.004,OR=4.849,95%CI:1.654~14.212),发作类型(P=0.011,OR=3.527,95%CI:1.330~9.349),服用抗癫痫药物量(P=0.012,OR=3.862,95%CI:1.341~11.124)为部分性发作癫痫患儿智力发育的独立影响因素。病程、年龄等因素与智力发育没有显著性关系。 【结论】 首发年龄小、发作频率高、MRI阳性、发作类型为继发全面性发作、服用抗癫痫药物量大的部分性发作癫痫患儿智力发育更容易受损。     

Risk factors for enteric perforation in patients with typhoid Fever

A case-control study was performed using the records of patients hospitalized for typhoid fever at Dicle University Hospital, Diyarbakir, Turkey, between 1994 and 1998. Case patients with enteric perforation were compared with control patients with typhoid fever but no enteric perforation. Risk factors for perforation were determined using logistic regression modeling. Forty case patients who had surgery because of typhoid enteric perforation were compared with 80 control patients. In univariate analyses, male sex (p = 0.01), age (p = 0.01), leukopenia (p = 0.01), inadequate antimicrobial therapy prior to admission (p = 0.01), and short duration of symptoms (p = 0.01) were significantly associated with perforation. In multivariate analysis, male sex (odds ratio (OR) = 4.39, 95% confidence interval (CI): 1.37, 14.09; p = 0.01), leukopenia (OR = 3.88, 95% CI: 1.46, 10.33; p = 0.04), inadequate treatment prior to admission (OR = 4.58, 95% CI: 1.14, 18.35; p = 0.03), and short duration of symptoms (OR = 1.22, 95% CI: 1.10, 1.35; p = 0.001) were significant predictors of perforation. A short duration of symptoms, inadequate antimicrobial therapy, male sex, and leukopenia are independent risk factors for enteric perforation in patients with typhoid fever.     

Age and race/ethnicity-gender predictors of denying smoking, United States

Smoking is a major risk factor for many chronic diseases. Nearly all studies collecting smoking data use self-reports, which are very rarely validated. We identified 15,182 adults 18 years or older in the Third National Health and Nutrition Examination Survey. Denying smoking, the main outcome, was defined as cotinine-determined smokers self-reporting non-smoking. Multiple logistic regression modeling took into account the complex survey design and sample weights. Age and race/ethnicity-gender categories predicted denying smoking. Smokers denying smoking ranged from 0.0% for elderly (75 years and older) Mexican-American women to 67.8% for elderly non-Hispanic Black women. Among elderly smokers, non-Hispanic Black women were more likely to deny smoking than both non-Hispanic White women (odds ratio (OR) = 8.9, 95% confidence interval (CI): 2.1-38.3) and non-Hispanic Black men (OR=21.4 95% CI: 4.3-107.2). This U.S. population-based study of age-specific race/ethnicity-gender predictors of denying smoking suggests caution in interpreting smoking-related survey data.     

老年人日常活动能力与睡眠质量及其交互作用对认知功能的影响

目的 探究我国老年人日常活动能力、睡眠质量及其交互作用对认知功能的影响。方法 基于2018年中国老年健康影响因素跟踪调查（CLHLS）数据,运用logistic回归模型进行危险因素分析。结果 控制相关变量后,多因素logistic回归结果显示,日常活动能力受损（OR = 3.941,95%CI:3.464～4.484）、睡眠障碍（OR = 1.370,95%CI:1.167～1.608）是老年人发生认知功能障碍的影响因素。交互作用结果显示,日常活动受损与睡眠障碍对认知功能障碍的发生具有相加交互作用（OR = 5.492,95%CI:4.380～6.888）,RERI（95%CI） = 1.261（0.092～2.430）,AP（95%CI） = 0.230（0.057～0.402）,S（95%CI） = 1.390（1.052～1.837）。结论 同时存在日常活动能力受损和睡眠障碍会增加老年人认知障碍的发生风险,通过有效措施提高老年人的睡眠质量和日常活动能力可有助于降低认知障碍的发生风险。     

Homocysteine levels in patients classified according to Lesch's typology

AIMS: It has been suggested that elevated total plasma homocysteine levels might be useful to predict alcohol withdrawal seizures. The typology by Lesch distinguishes between four subtypes of which type 1 suffers from marked withdrawal symptoms, including alcohol withdrawal seizures. This study was undertaken to investigate total plasma homocysteine levels in actively drinking patients with alcoholism who were classified according to Lesch's typology. Subjects and methods: We determined total plasma homocysteine levels in 144 non-abstinent chronic alcoholics (115 men, 29 women; aged 22-67 years). Patients were classified in Lesch's typology (LT) and were divided into two groups: LT 1 (n = 27) and LT 2-4 (n = 117). Within the groups, patients with or without a history of alcohol withdrawal seizures were differentiated. RESULTS: All patients with a history of alcohol withdrawal seizures had significantly elevated plasma homocysteine concentrations at admission when compared with those without seizures (Mann-Whitney U, P < 0.001). Furthermore, patients classified as LT 1 who suffered from an alcohol withdrawal seizure (n = 12) had significantly higher plasma homocysteine levels (Z = -2.31, P = 0.02) when compared to the corresponding types 2-4 (n = 24). Using a logistic regression analysis, withdrawal seizures were best predicted by a high homocysteine level at admission but even more pronounced in LT 1 (Wald's chi-squared [chi(2)] = 10.7; odds ratio [OR] 1.24; 95% confidence interval [CI] 1.03-1.51; P < 0.001) when compared with LT 2-4 (chi(2) = 10.6; OR 1.06; 95%CI 1.03-1.14; P = 0.004). CONCLUSION: To our knowledge, this is the first study evaluating homocysteine levels in patients who were classified according to Lesch's typology. Homocysteine levels on admission may be a useful screening method to identify actively drinking patients at risk of alcohol withdrawal seizures, especially in alcoholics with Lesch type 1.     

Predictors of work-related repetitive strain injuries in a population cohort

OBJECTIVES: We assessed predictors of work-related repetitive strain injuries using data from 4 waves of the Canadian National Population Health Survey. METHODS: Participants were 2806 working adults who completed an abbreviated version of the Job Content Questionnaire in 1994-1995 and did not experience repetitive strain injuries prior to 2000-2001. Potential previous wave predictors of work-related repetitive strain injuries were modeled via multivariate logistic regression. RESULTS: Female gender (odds ratio [OR] = 1.98; 95% confidence interval [CI]=1.24, 3.18), some college or university education (OR=1.98; 95% CI=1.06, 3.70), job insecurity (OR=1.76; 95% CI=1.07, 2.91), high physical exertion levels (OR = 2.00; 95% CI = 1.29, 3.12), and high levels of psychological demands (OR = 1.61; 95% CI = 1.02, 2.52) were all positively associated with work-related repetitive strain injuries, whereas working less than 30 hours per week exhibited a negative association with such injuries (OR=0.2; 95% CI=0.1, 0.7). CONCLUSIONS: Modifiable job characteristics are important predictors of work-related repetitive strain injuries.     

Age, obesity, and medical visits in family medicine

The purpose of this study was to assess whether the relationship between obesity and use of medical visits is different for geriatric patients than for other adults. A retrospective analysis was conducted using medical records drawn from a large group practice in Rochester, Minnesota. Adult patients (n = 1715) were sorted into 2 groups (frequent visitors and others). Separate multiple logistic regression models were estimated for geriatric and non-geriatric patients. Patients who were 65 years of age or older with moderate comorbidity had elevated odds of being frequent visitors (odds ratio [OR] = 6.13, confidence interval [CI] = 3.27-11.49), compared to patients with no comorbidity. Body mass index (BMI), gender, and marital status were unrelated to visit frequency in the geriatric group. Younger patients with a BMI >or= 35 kg/m2 had greater odds of being frequent visitors compared to patients with normal body mass, after adjusting for comorbidity, age, marital status, and gender (OR = 1.96, CI = 1.31-2.92). ORs also were significantly greater for subjects with low (OR = 2.13, CI = 1.51-3.01) and moderate comorbidity (OR = 3.32, CI = 2.32-4.76) versus no comorbidity. In our sample of family medicine patients who were referred to specialists, BMI >or= 35 kg/m2 is an independent risk factor for frequent utilization of medical visits among adults who are younger than age 65, but not among geriatric patients. Comorbidity is strongly related to visit frequency among both older and younger adult patients.     

东莞市结核病患者就诊延迟及影响因素分析

目的 分析东莞市结核病患者的就诊延迟特征及影响因素,为结核病防治提供科学依据。 方法 收集2018年东莞市3 865例结核病患者病案信息。采用秩和检验和多重线性回归分析就诊天数的影响因素,采用χ²检验和logistic回归分析就诊延迟率的影响因素。 结果 结核病患者就诊天数的中位数为28 d,就诊延迟率为69.5%。多重线性回归提示,女性、年龄增大、农民和离退人员、病原学阳性、有合并其他结核是就诊天数增加的危险因素。多因素logistic回归分析表明,女性(OR=1.26)、年龄较大(OR=1.15)、离退人员(OR=2.14)、病原学阳性(OR=1.97)和单纯结核性胸膜炎(OR=1.81)、患者来源为追踪/其他(OR=3.67)、有合并症(OR=1.61)、有合并其他结核(OR=2.13)均为就诊延迟的危险因素。 结论 今后应重点关注女性、中老年、农民和离退人员结核病患者的就诊延迟问题。