癫痫杂志

癫痫杂志

中低收入国家癫痫过早死亡:国际抗癫痫联盟死亡率专业组系统评价

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为了确定中低收入国家(Low- and middle-income countries,LMICs)癫痫相关的危险因素大小与过早死亡原因,专业组对来自 LMICs(世界银行定义)的死亡率及癫痫相关文献报道进行系统检索,根据代表性,病例、诊断和死亡率的确证度对研究进行评估,并提取癫痫患者中的标准化死亡比(Standardized mortality ratios,SMR)和死亡率数据。研究调查了死亡的危险因素和原因。据估计,在高质量的群体研究中,癫痫患者年死亡率为 19.8/1 000(9.7/1 000~45.1/1 000),加权中位 SMR 为 2.6(1.3~7.2)。而临床队列研究显示的死亡率为 7.1/1 000(1.6/1 000~25.1/1 000),加权中位 SMR 在男性中为 5.0,女性中为 4.5。在儿童和青少年、症状性癫痫或治疗依从性低的患者中发现了相对较高的 SMR。群体研究显示,LMICs 癫痫患者死亡的主要原因中直接归因于癫痫的平均比例死亡比(Proportional mortality ratio,PMR)为 27.3%(5.0%~73.5%)。这些直接原因包括癫痫持续状态(报道的 PMR 为 5.0%~56.5%)和癫痫猝死(Sudden unexpected death in epilepsy,SUDEP)(报道的 PMR 为 1.0%~18.9%),与癫痫相关的间接死亡原因包括溺水、头部创伤和烧伤。LMICs 癫痫患者的早亡率明显高于高收入国家。在 LMICs,死亡率过高可能与患者难以获得医疗资源有关,例如发生癫痫持续状态时,以及包括溺水、头外伤和烧伤在内的可预防死因。这类过高的早亡率可以通过进行关于死亡风险的教育,提高治疗,包括抗癫痫药物治疗的可得性而大大降低。

关键词: 痫性发作; 强直; 死亡; 病死; 发展中国家; 资源贫乏国家; 早亡

引用本文: LeviraF, ThurmanDJ, SanderJW, 陆璐 译, 童馨 慕洁 审. 中低收入国家癫痫过早死亡:国际抗癫痫联盟死亡率专业组系统评价. 癫痫杂志, 2019, 5(1): 47-56. doi: 10.7507/2096-0247.20190010 复制

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