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目的探讨儿童症状性癫癎常见病因及不同年龄段病因构成特点。方法以2004年1月至2007年1月在湖南省儿童医院神经内科住院的308例症状性癫癎患儿为病例组,同期住院的202例非癎性发作患儿为对照组,采用前瞻性调查方法并通过自制问卷调查表对两组患儿的家长进行调查;对所有病例均进行了详细体格及神经系统检查;所有患儿均查脑电图、头颅CT和(或)头颅MRI。采用单因素和多因素分析;对各组病因构成比进行χ2检验。结果(1)单因素分析显示围生期损伤、先天性脑发育异常、颅内感染、热性惊厥、神经皮肤综合征、颅脑外伤等与儿童症状性癫癎相关(P<0.05)。将其引入多因素Logistic回归模型,显示儿童症状性癫癎与围生期损伤、先天性脑发育异常、颅内感染、热性惊厥有显著相关。(2)<1岁、~3岁、~7岁、~14岁患儿的首要病因分别为先天性脑发育异常、围生期损伤、颅内感染、颅脑外伤,且不同年龄段主要病因分布的构成比差异具有统计学意义(P<0.05)。(3)308例症状性癫癎患儿中局灶性发作164例(53.2%),全面性发作144例(46.8%)。围生期损伤、先天性脑发育异常、神经皮肤综合征、中毒性脑病以全面性发作为主;颅内感染、热性惊厥、颅脑外伤、颅内肿瘤以局灶性发作为主。癫癎脑病24例主要见于神经皮肤综合征、围生期损伤及先天性脑发育异常。结论儿童症状性癫癎常见病因依次为围生期损伤、先天性脑发育异常、颅内感染、热性惊厥、神经皮肤综合征、颅脑外伤等,且不同年龄段病因的构成比明显不同。癫癎的发作类型以局灶性发作多见。
Objective To investigate the common etiology of children with symptomatic epilepsy and the etiological characteristics of different age groups. Methods From January 2004 to January 2007, 308 cases of symptomatic epilepsy inpatients hospitalized in Hunan Provincial Children’s Hospital were enrolled as the case group. 202 cases of non-seizure hospitalized in the same period as the control group were prospectively Survey methods and through self-made questionnaire survey of two groups of parents of children; all cases were detailed physical and neurological examination; all children were checked EEG, head CT and (or) cranial MRI. Univariate and multivariate analysis were used to analyze the etiology of each group. Results (1) Univariate analysis showed that perinatal injury, congenital brain dysplasia, intracranial infection, febrile seizures, neurocutaneous syndrome and craniocerebral trauma were associated with symptomatic epilepsy in children (P <0.05). Introduced into the multivariate Logistic regression model, showed that children with symptomatic epilepsy and perinatal damage, congenital brain dysplasia, intracranial infection, febrile convulsion were significantly related. (2) The primary causes of children <1 year old, ~ 3 years old, ~ 7 years old and ~ 14 years old were respectively congenital brain dysplasia, perinatal injury, intracranial infection, craniocerebral trauma and the main causes of different ages Distribution of composition ratio was statistically significant (P <0.05). (3) There were 164 cases (53.2%) of the 308 patients with symptomatic epilepsy and 144 cases (46.8%) of the generalized attacks. Perinatal injury, congenital brain dysplasia, neurodermatosis, toxic encephalopathy with a comprehensive attack based; intracranial infection, febrile seizures, traumatic brain injury, intracranial tumors with focal attack. Epileptic encephalopathy in 24 cases mainly seen in neurodermal syndrome, perinatal damage and congenital brain dysplasia. Conclusions The common causes of symptomatic epilepsy in children are perinatal injury, congenital brain dysplasia, intracranial infection, febrile seizures, neurodermal syndrome, craniocerebral trauma and so on, and the causes of the different age groups are significantly different. Epileptic seizures to the type of seizure more common.