轻、中型颅脑损伤儿童并发外伤性癫痫的危险因素分析

目的探索儿童轻、中型创伤性颅脑损伤（TBI）后发生外伤性癫痫（PTE）的危险因素，为临床防治PTE提供参考依据。方法回顾性分析成都医学院第二附属医院·核工业四一六医院神经外科2015年1月1日—2023年1月1日收治的259例轻、中型创伤性颅脑损伤（TBI）患儿的临床资料。将259例患儿分为PTE组（52例）与非PTE组（207例）。采用单因素分析和多因素Logistic回归分析影响儿童轻、中型TBI后PTE发生的相关危险因素。结果变量筛选结果提示在磁共振（MRI）提示含铁血黄素沉积、急诊计算机断层扫描（CT）结果、脑电图（EEG）异常类别、白细胞介素（IL）-1、IL-6、IL-8、纤维蛋白原升高等方面，PTE与非PTE组差异具有统计学意义（P＜0.05）。多因素Logistic回归分析显示，急诊CT提示单一创伤性蛛网膜下腔出血、MRI提示含铁血黄素沉积、EEG提示睡眠纺锤波减少、IL-8升高是儿童轻、中型颅脑损伤后PTE发生的独立危险因素（P＜0.05）。结论急诊CT提示单一创伤性蛛网膜下腔出血，MRI提示含铁血黄素沉积，EEG提示睡眠纺锤波减少或消失，IL-8升高是儿童轻、中型TBI后发生PTE的独立危险因素。我们认为对具有上述危险因素的轻、中型TBI患儿采取相关的防治措施，可以降低PTE的发生率。

Objective To explore the risk factors of post-traumatic epilepsy(PTE) in children with mild and medium traumatic brain injury(TBI), and to provide reference for clinical prevention and treatment of PTE. Methods The clinical data of 259 children with mild and medium craniocerebral injuries who were admitted to the Department of Neurosurgery, 416 Hospital, the Second Affiliated Hospital of Chengdu Medical College, from January 1, 2015 to January 1, 2023 were analyzed retrospectively. 259 children were classified into PTE group(52) and non-PTE group(207) based on hospitalization and diagnosis of epilepsy within 6 months of discharge. Univariate analysis and multivariate logistic regression were used to analyze the risk factors of PTE after mild and medium TBI in children. Results The results of univariate analysis showed that there were statistically significant differences between PTE and non-PTE groups in the categories of brain injury indicated by magnetic resonance imaging(MRI) showed hemosiderin deposition, emergency computer tomography(CT), abnormal categories of electroencephalogram(EEG), interleukin(IL)-1, IL-6, IL-8 and fibrinogen elevated levels(P<0.05). Multivariate logistic regression analysis showed that emergency CT showed traumatic subarachnoid hemorrhage, MRI showed hemositin deposition, EEG showed decreased or disappeared sleep spindles, and elevated IL-8 were independent risk factors for PTE in children with mild and moderate head injury(P<0.05). Conclusions Emergency CT shows traumatic subarachnoid hemorrhage. MRI shows hemosiderin deposition. EEG shows decreased or disappeared sleep spindles, and elevates IL-8 are independent risk factors for PTE after mild and moderate TBI in children. The incidence of PTE can be reduced by taking relevant prevention and treatment measures for mild and medium TBI children with the above risk factors.