倾向性评分匹配分析他汀类药物对卒中后癫痫的影响

Propensity Score-Matched Analysis of the Effect of Statins on Post-Stroke Epilepsy

摘要: 目的：应用倾向性评分方法分析卒中急性期(7天内)他汀类药物对卒中后癫痫的影响并进行验证。方法：回顾性分析2019年1月至2020年6月青岛大学附属医院及青岛市立医院收治的5477例脑梗死患者的病例资料，最终入组患者3069例，其中123例出现卒中后癫痫。以123例癫痫患者为癫痫组，其余患者为对照组，先后进行单因素、多因素分析，将有统计学意义的因素纳入倾向性评分匹配。以急性期(7天内)应用他汀类药物为因变量，癫痫发作为自变量。以年龄、性别、高血压等基线资料及多因素回归分析中卒中严重程度(NIHSS评分)、卒中相关性感染(stroke-associated infection, SAI)、心源性栓塞、他汀类药物等有统计学意义的指标为匹配变量，卡钳尺度为0.2 SD，以1:1的比例进行匹配。通过构建多因素Logistic回归模型分析卒中后癫痫发作的危险因素及他汀类药物对卒中后癫痫患者的影响。结果：匹配前皮层受累、卒中严重程度(NIHSS评分)、心源性栓塞型卒中、急性期(7天内)未应用他汀类药物、SAI、早发性痫性发作、NLR是卒中后癫痫发作的危险因素，癫痫组与对照组间差异有统计学意义(P < 0.05)。匹配后倾向性得分在是否服用他汀类药物间分布基本均衡，本次匹配较为成功，PSM后，共匹配得到47对，共94例。各项混杂因素在他汀与非他汀组间差异无统计学意义，分布平衡(P > 0.05)，PSM后的变量分析显示，应用他汀类药物与卒中后癫痫发生显著相关。停用他汀类药物的患者更容易出现PSE (OR = 4.110; 95%CI = 1.229~13.750, P = 0.022)。结论：急性期(7天内)未应用他汀类药物与卒中患者癫痫发生具有相关性，是卒中后癫痫的独立危险因素。

Abstract: Objective: To analyze the impact of statins on post-stroke epilepsy during the acute phase (within 7 days) using propensity score matching and validate the results. Methods: A retrospective analysis was conducted on the medical records of 5477 patients with cerebral infarction who were admitted to the Affiliated Hospital of Qingdao University and Qingdao Municipal Hospital from January 2019 to June 2020. A total of 3069 patients were ultimately included in the study, of which 123 developed post-stroke epilepsy. The 123 epilepsy patients were classified into the epilepsy group, and the remaining patients served as the control group. Univariate and multivariate analyses were performed, and statistically significant factors were included in the propensity score matching. Statin use during the acute phase (within 7 days) was set as the dependent variable, and epilepsy occurrence was the independent variable. Baseline characteristics such as age, gender, hypertension, and statistically significant indicators from multivariate regression analysis, including stroke severity (NIHSS score), stroke-associated infection (SAI), cardiogenic embolism, and statin use, were used as matching variables. The caliper scale was set at 0.2 SD, and a 1:1 matching ratio was applied. A multivariate logistic regression model was constructed to analyze the risk factors for post-stroke epilepsy and the impact of statins on post-stroke epilepsy patients. Results: Before matching, cortical involvement, stroke severity (NIHSS score), cardiogenic embolism type of stroke, non-use of statins during the acute phase (within 7 days), SAI, early-onset epileptic seizures, and NLR were identified as risk factors for post-stroke epilepsy, with significant differences between the epilepsy group and the control group (P < 0.05). After matching, the distribution of propensity scores between statin use and non-use groups was balanced, indicating successful matching. After propensity score matching (PSM), 47 matched pairs (94 cases) were obtained. No statistically significant differences in confounding factors were found between the statin and non-statin groups, and the distribution was balanced (P > 0.05). The analysis of variables after PSM showed that statin use was significantly associated with the occurrence of post-stroke epilepsy. Patients who discontinued statins were more likely to experience post-stroke epilepsy (OR = 4.110; 95% CI = 1.229~13.750, P = 0.022). Conclusion: Non-use of statins during the acute phase (within 7 days) is associated with the occurrence of epilepsy in stroke patients and is an independent risk factor for post-stroke epilepsy.