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目的探讨糖尿病相关癫痫发作的临床特征及危险因素。方法对重庆医科大学附属第二医院2013年10月-2015年3月住院的44例糖尿病相关癫痫发作患者的癫痫发作临床分型、脑电图(EEG)、血糖、糖化血红蛋白、钠离子、血浆渗透压、脑核磁共振、抗癫痫药物(AEDs)的应用进行分析。结果 (1)糖尿病高血糖症相关癫痫发作:平均发病年龄51.3岁,男17例,女11例;简单部分性发作,不伴继发性全面性发作是最常见的临床类型(12/28,42.8%),8例(8/28,28.6%)复杂部分发作,8例(8/28,28.6%)没有明确局灶起源的全面性强直阵挛发作;糖化血红蛋白>9%的患者比≤9%的出现全面性发作(46.7%vs.7.7%,P<0.05)风险要高;(2)糖尿病酮症酸中毒及高血糖高渗状态相关癫痫发作:平均发病年龄45.7岁,男6例,女1例;全面性强直阵挛发作2例(2/7,28.6%),癫痫持续状态2例(2/7,28.6%),局部性运动发作2例(2/7,28.6%),Jackon发作1例(1/7,14.2%);(3)糖尿病低血糖症相关癫痫发作:平均发病年龄45.3岁,男7例,女2例;全面性强直阵挛发作5例(5/9,55.6%),复杂部分发作3例(3/9,33.3%),全身强直发作1例(1/9,11.1%)。结论糖尿病高血糖症患者癫痫发作最常见为部分性运动发作,而低血糖、高血糖酮症酸中毒相对较常见者为全面性发作。糖化血红蛋白水平升高是糖尿病高血糖症相关癫痫发作的危险因素。
Objective To investigate the clinical features and risk factors of diabetes-related seizures. Methods Seventy-four patients with seizures, EEG, blood glucose, glycosylated hemoglobin, sodium, plasma and plasma levels of 44 patients with diabetes mellitus-related seizures admitted to the Second Affiliated Hospital of Chongqing Medical University from October 2013 to March 2015 were enrolled. Osmotic pressure, cerebral magnetic resonance imaging, antiepileptic drugs (AEDs). Results (1) Diabetic hyperglycemia-related seizures: The average age of onset was 51.3 years old, with 17 males and 11 females. Simple partial seizures without secondary generalized seizures were the most common clinical types (12/28, 42.8%), 8 cases (8 / 28,28.6%) complicated partial seizures, 8 cases (8 / 28,28.6%) did not have clear focal origin of the comprehensive tonic clonic seizures; patients with glycosylated hemoglobin> 9% (46.7% vs.7.7%, P <0.05). (2) Diabetic ketoacidosis and hyperglycemia associated with seizures: The average age of onset was 45.7 years (range, 6 males (2/7, 28.6%), status epilepticus in 2 cases (2/7, 28.6%), locomotor activity in 2 cases (2/7, 28.6%), , Jackon attack in 1 case (1/7, 14.2%); (3) diabetic hypoglycemia-related seizures: the average age of onset 45.3 years, 7 males and 2 females; 5 cases of comprehensive tonic clonic seizures (5 / 9,55.6%), complicated part attack in 3 cases (3 / 9,33.3%) and generalized tonic attack in 1 case (1 / 9,11.1%). Conclusion The most common seizures in patients with diabetic hyperglycemia are partial seizures, whereas those with hypoglycemia and hyperglycemic ketoacidosis are more common. HbAlc levels are a risk factor for diabetic hyperglycemia-related seizures.