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目的 探讨家庭因素对癫痫患者预后的影响及其与癫痫临床特征之间的关系.方法 连续收集2016年9月至2017年5月就诊于南京医科大学附属脑科医院的107例确诊癫痫患者,至少规范治疗2年,以治疗期内是否达到至少1年无发作分为预后好与预后差组.收集患者的临床和家庭资料,采用家庭亲密度和适应性量表对癫痫患者进行问卷调查,并对患者主要照顾者进行一项包含34个问题的癫痫知识问答.采用Logistic回归分析临床和家庭因素对癫痫患者预后的影响,应用Pearson相关分析观察家庭因素与癫痫患者病程、发作类型、发作频率等临床特征的关系.结果 预后差组患者脑电图发作间期癫痫样放电、多药治疗及治疗前发作频率＞1次／月的比例高于预后好组[84.6％ (44/52)与50.9 ％(28/55),x2=13.797,P=0.000;63.5％ (33/52)与34.5％ (19/55),x2=8.947,P=0.003;38.5％ (20/52)与5.5％ (3/55),x2=17.257,P=0.000].预后差组患者家庭所处农村、失衡家庭类型的比例和家庭人口数多于预后好组[51.9％ (27/52)与25.5％(14/55),x2 =7.923,P=0.005;80.8％ (42/52)与49.1％ (27/55),x2=11.712,P=0.000;4.1±1.1与3.6±0.8,=2.631,P=0.010];而家庭人均收入、父亲文化程度、主要照顾者癫痫知识水平均低于预后好组(19/20/13与11/17/27,x2=7.198,P=0.027;15/30/7与4/34/17,x2=10.709,P=0.005;36/11/5与15/25/15,x2=19.022,P=0.000).多因素Logistic回归分析显示,发作间期癫痫样放电(0R=12.332,95％ CI2.756～55.190,P=0.001)、治疗前发作频率＞1次／月(OR=8.401,95％ CI 1.573 ～44.884,P=0.013)是癫痫预后差的独立临床危险因素;家庭人口数多(OR=3.021,95％ CI 1.554 ～5.870,P=0.001)、主要照顾者癫痫知识水平差(OR=3.392,95％ CI1.304 ～8.821,P=0.012)及失衡家庭类型(OR =4.794,95％ CI1.217 ～ 18.894,P=0.025)是癫痫预后差的独立家庭危险因素.主要照顾者癫痫知识水平与患者病程呈负相关(r=-0.237,P=0.014).结论 癫痫患者的预后不仅受临床因素影响,而且受家庭因素影响;家庭人口数多、主要照顾者癫痫知识水平差和失平衡家庭类型是癫痫预后差的独立危险因素.主要照顾者癫痫知识水平越差,患者病程越长.

Objective To investigate the effect of family factors on the prognosis of patients with epilepsy and the relationship between family factors and clinical characteristics of epilepsy.Methods Data were collected from 107 patients definitely diagnosed with epilepsy who were treated by antiepileptic drugs for at least two years.All the patients were divided into good or poor prognosis group according to whether achieving at least one year free of seizures.The clinical and family data were colleeted.The questionnaire Family Adaptability and Cohesion Evaluation Scale-Ⅱ-Chinese Version containing 30 items was used for patients and the Epilepsy Knowledge Questionnaire containing 34 questions for primary caregiver.We compared the clinical and family factors between the two groups to identify the predictors of poor control of seizures with univariate and multiple Logistic regression,and observed the relationship between family factors and clinical features such as course,type of seizure,seizure frequency,etc,with Pearson correlation analysis.Results Patients with poor prognosis were more likely to have interictal epileptiform discharges (IEDs),multidrug treatment and pre-treatment seizure frequency of more than once monthly (84.6％ (44/52) vs 50.9 ％ (28/55),x2 =13.797,P =0.000;63.5 ％ (33/52) vs 34.5 ％ (19/55),x2 =8.947,P =0.003;38.5％ (20/52) vs 5.5％ (3/55),x2 =17.257,P =0.000).Family in rural area,unbalanced family type,number of family members were much more in poor prognosis group than in good prognosis group (51.9％ (27/52) vs 25.5 ％ (14/55),x2 =7.923,P =0.005;80.8 ％ (42/52) vs 49.1％ (27/55),x2 =11.712,P=0.000;4.1 ± 1.1 vs 3.6 ±0.8,t=2.631,P=0.010).And average family income,education level of father,the level of epilepsy knowledge of primary caregiver were significantly lower in poor prognosis group than in good prognosis group (19/20/13 vs 11/17/27,x2 =7.198,P =0.027;15/30/7 vs 4/34/17,x2 =10.709,P =0.005;36/11/5 vs 15/25/15,x2 =19.022,P =0.000).Multiple Logistic regression analysis demonstrated that IEDs (OR =12.332,95％ CI 2.756-55.190,P =0.001),pretreatment seizure frequency of more than once monthly (OR =8.401,95％ CI 1.573-44.884,P =0.013)were clinical risk factors of unfavorable prognosis;more family members (OR =3.021,95％ CI 1.554-5.870,P =0.001),poor epilepsy knowledge of primary caregiver (OR =3.392,95％ CI 1.304-8.821,P=0.012) and unbalanced family type (OR=4.794,95％ CI 1.217-18.894,P=0.025) were independent family risk factors of poor prognosis.The level of epilepsy knowledge of primary caregiver was inversely associated with duration (r =-0.237,P =0.014).Conclusions The prognosis of epilepsy is not only affected by clinical factors,but also by family factors.More family members,poor epilepsy knowledge of primary caregiver and unbalanced family type are independent risk factors of unfavorable prognosis.The poorer epilepsy knowledge the primary caregivers have,the longer duration the disease has.