Correlation between EEG characteristics and neuropeptide Y and epilepsy risk after acute stroke
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摘要:
目的 探讨脑电图特征和神经肽Y水平对急性脑卒中后癫痫发生风险的影响，并对相关因素进行分析。 方法 选取2021年3月—2022年3月湖州市第一人民医院收治的46例急性脑卒中后癫痫患者作为癫痫组，再选取同期接受治疗的43例急性脑卒中后非癫痫患者作为非癫痫组。所有受试者均给予至少2 h的脑电图监测，并检测其神经肽Y水平，分析神经肽Y水平和脑电图特征与急性脑卒中后癫痫的相关性。 结果 癫痫组患者慢波指数、脑对称指数(BSI)及脑电图慢波化比率(DTABR)均高于非癫痫组(P < 0.05)；癫痫组患者神经肽Y水平低于非癫痫组，神经元特异烯醇化酶(NSE)、同型半胱氨酸(Hcy)及超敏C反应蛋白(hs-CRP)水平均高于非癫痫组(P < 0.05)。多因素logistic回归分析显示，神经肽Y(OR=0.671)、NSE(OR=1.174)水平、慢波指数(OR=1.124)以及BSI(OR=1.344)均是急性脑卒中后癫痫发生的独立影响因素(P < 0.05)。ROC曲线显示，神经肽Y、慢波指数及BSI联合预测急性脑卒中后癫痫发生的效能最高，其AUC为0.976，灵敏度为93.48%，特异度为97.67%。 结论 脑电图特征的异常改变和神经肽Y水平的降低是导致急性脑卒中后癫痫发生的危险因素，神经肽Y水平和脑电图特征可用于预测急性脑卒中后癫痫。 Abstract:Objective To explore the influence of EEG characteristics and neuropeptide Y level on the risk of epilepsy after acute stroke, and analyze the related factors. Methods A total of 46 patients with epilepsy after acute stroke treated in Huzhou First People' s Hospital from March 2021 to March 2022 were selected as the research object, and 43 patients with non-epilepsy after acute stroke treated in the same period were selected as the observation control. All subjects were given EEG monitoring for at least 2 hours, and their neuropeptide Y levels were detected, and the correlation between their levels and EEG characteristics and the progress of epilepsy after acute stroke was analyzed. Results Slow wave index, BSI, and DTABR in the epileptic group were higher than those in the non-epileptic group (P < 0.05). The levels of neuropeptide Y in the epileptic group were lower than those in the non-epileptic group, and the levels of NSE, Hcy, and hs-CRP were higher than those in the non-epileptic group (P < 0.05). Multivariate logistic regression analysis showed that neuropeptide Y (OR=0.671), NSE (OR=1.174), slow wave index (OR=1.124), and BSI (OR=1.344) were independent risk factors for epilepsy after acute stroke (P < 0.05). ROC curve showed that the combined prediction of neuropeptide Y, slow wave index and BSI has the highest prediction efficiency, with AUC of 0.976, sensitivity of 93.48%, and specificity of 97.67%. Conclusion Abnormal changes in EEG characteristics and the decrease of neuropeptide Y level are risk factors for epilepsy after acute stroke. Neuropeptide Y level and EEG characteristics can be used to prevent and treat epilepsy after acute stroke. -
Key words:
- Epilepsy after stroke /
- Electroencephalogram /
- Serum neuropeptide Y /
- Ischemic stroke /
- Risk factor /
- Correlation
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表 1 2组急性脑卒中患者一般资料比较
Table 1. Comparison of general data between two groups of patients with acute stroke
项目 癫痫组(n=46) 非癫痫组(n=43) 统计量 P值 年龄(x±s，岁) 68.25±6.48 69.37±7.63 0.744a 0.459 性别[例(%)] 0.835b 0.361 男性 29(63.04) 23(53.49) 女性 17(36.96) 20(46.51) 病程(x±s，月) 4.85±1.37 5.03±1.54 0.581a 0.563 病灶部位[例(%)] 4.861b 0.027 大脑皮质 31(67.39) 19(44.19) 其他 15(32.61) 24(55.81) 病变偏侧[例(%)] 0.252b 0.882 左侧 18(39.13) 15(34.88) 右侧 19(41.30) 18(41.86) 双侧 9(19.57) 10(23.26) 吸烟史[例(%)] 15(32.61) 13(30.23) 0.058b 0.809 饮酒史[例(%)] 11(23.91) 9(20.93) 0.113b 0.736 家族癫痫史[例(%)] 4(8.70) 2(4.65) 0.578b 0.447 基础病史[例(%)] 高血压 23(50.00) 17(39.53) 0.984b 0.321 糖尿病 9(19.57) 7(16.28) 0.163b 0.687 高血脂 8(17.39) 10(23.26) 0.474b 0.491 冠心病 11(23.91) 13(30.23) 0.451b 0.502 NIHSS评分(x±s，分) 13.25±2.63 11.81±3.12 2.346a 0.021 注：a为t值，b为χ2值。 
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表 2 2组急性脑卒中患者血液检查指标和脑电图特征比较(x±s)
Table 2. characteristics between two groups of acute stroke patients (x±s)
项目 癫痫组
(n=46)非癫痫组
(n=43)t值 P值 血液检查指标 神经肽Y(ng/mL) 86.15±8.87 108.15±9.22 11.457 ＜0.001 NSE(μg/L) 24.98±3.09 20.58±4.06 5.724 ＜0.001 Hcy(μmol/L) 14.85±3.76 12.05±2.45 4.188 ＜0.001 hs-CRP(mg/L) 3.06±0.77 2.64±0.81 2.503 0.014 脑电图特征 慢波指数 1.63±0.21 1.16±0.15 12.209 ＜0.001 BSI 0.43±0.09 0.17±0.04 17.803 ＜0.001 DTABR 10.31±2.15 8.26±1.55 5.184 ＜0.001
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表 3 急性脑卒中后癫痫发生的单因素logistic回归分析
Table 3. Univariate logistic regression analysis of post-stroke epilepsy
变量 B SE Waldχ2 P值 OR值 95% CI 病灶部位 0.960 0.440 4.765 0.029 2.611 1.103~6.179 NIHSS评分 0.218 0.084 6.773 0.009 1.243 1.055~1.465 神经肽Y -0.265 0.059 20.440 < 0.001 0.767 0.684~0.860 NSE 0.102 0.029 12.146 < 0.001 1.107 1.046~1.172 Hcy 0.203 0.074 7.579 0.006 1.225 1.060~1.415 hs-CRP 0.476 0.103 21.266 < 0.001 1.609 1.315~1.970 慢波指数 0.136 0.028 23.389 < 0.001 1.146 1.084~1.211 BSI 0.334 0.073 21.102 < 0.001 1.396 1.211~1.610 DTABR 0.048 0.019 6.275 0.012 1.050 1.011~1.090
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表 4 急性脑卒中后癫痫发生的多因素logistic回归分析
Table 4. Multivariate logistic regression analysis of post-stroke epilepsy
变量 B SE Waldχ2 P值 OR值 95% CI 病灶部位 2.816 1.754 2.575 0.109 16.702 0.536~520.215 NIHSS评分 0.061 0.215 0.081 0.776 1.063 0.698~1.620 神经肽Y -0.400 0.149 7.203 0.007 0.671 0.501~0.898 NSE 0.161 0.077 4.300 0.038 1.174 1.009~1.367 Hcy 0.276 0.162 2.908 0.088 1.318 0.960~1.809 hs-CRP 0.606 0.332 3.325 0.068 1.832 0.956~3.513 慢波指数 0.117 0.038 9.666 0.002 1.124 1.044~1.210 BSI 0.295 0.107 7.565 0.006 1.344 1.089~1.659 DTABR 0.073 0.050 2.176 0.140 1.076 0.976~1.185
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表 5 脑电图特征和神经肽Y对急性脑卒中后癫痫的预测价值
Table 5. The predictive value of EEG characteristics and neuropeptide Y in post-stroke epilepsy
项目 截断值 AUC 灵敏度
(%)特异度
(%)95% CI Youden指数 神经肽Y 95.03 ng/mL 0.861 79.57 80.70 0.772~0.926 0.603 慢波指数 1.32 0.900 82.61 90.70 0.818~0.953 0.733 BSI 3.31 0.869 77.39 80.02 0.780~0.931 0.604 联合预测 0.976 93.48 97.67 0.919~0.997 0.912
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