Stroke:脑出血后癫痫药物的使用差异!

2017-01-21 MedSci MedSci原创

虽然多中心电子健康记录数据显示预防性使用癫痫发作药物存在明显的人种/种族差异,而更完整的单中心队列发现这一明显的差距会被高血压、血肿位置等临床因素所混淆。脑出血后的治疗存在差异是很常见的;然而,行政管理数据可能导致被详细的临床资料所混淆的差异不容易在电子健康记录中被发现。

近日,卒中领域权威杂志Stroke上发表了一篇研究文章,研究人员旨在评估了在脑出血患者预防性使用癫痫发作药物的潜在差异。

研究人员对同时具有前瞻性数据记录的多中心电子健康记录进行审查。电子健康记录的数据取自HealthLNK-伊利诺斯芝加哥从2006至2012年(多中心队列)多中心的电子病历库。其他数据为从2007至2015年前瞻性编码的数据(单中心队列)。

多中心队列纳入了4个HealthLNK中心的3422例患者。使用左乙拉西坦是根据不同人种/种族而有所不同(P= 0.0000008),使用左乙拉西坦的白人数量将近黑人的两倍(比值比为1.71;95%可信区间为1.43-2.05;P<0.0001)。在单中心队列研究中(n=450),血肿部位、更大的年龄、抑郁、更大的血肿量、不酗酒和人种/种族与左乙拉西坦的使用相关(P≤0.04)。接受左乙拉西坦治疗的白人是黑人的两倍(比值比为1.9;95%可信区间为1.25-2.89;P=0.002);然而,这种相关性会被高血压病、入院时血压较高和深部血肿位置所混淆。只有血肿部位与左乙拉西坦的使用独立相关(P<0.00001),而对于其他变量,包括人种/种族则并不显著。

由此可见,虽然多中心电子健康记录数据显示预防性使用癫痫发作药物存在明显的人种/种族差异,而更完整的单中心队列发现这一明显的差距会被高血压、血肿位置等临床因素所混淆。脑出血后的治疗存在差异是很常见的;然而,行政管理数据可能导致被详细的临床资料所混淆的差异不容易在电子健康记录中被发现。        

原始出处:

Andrew M. Naidech, et al. Disparities in the Use of Seizure Medications After Intracerebral Hemorrhage. Stroke. 2017. https://doi.org/10.1161/STROKEAHA.116.015779

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    2017-01-22 陈安安

    0

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    2017-01-22 往日如昨

    继续学习中

    0

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    2017-01-22 1dd8aa01m06(暂无匿称)

    内容很好,学习了

    0

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    2017-01-21 1e1263e3m20(暂无匿称)

    不错学习啦,多谢分享

    0

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    2017-01-21 现在

    学习中!!!

    0

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    2017-01-21 1e160a78m83(暂无匿称)

    学习啦,谢谢分享

    0

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    2017-01-21 1e1a50a1m36(暂无匿称)

    脑出血病人比较多,出血后出现癫痫的患者多见,好好学习,工作中遇到了,处理比较得心应手

    0

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    2017-01-21 珍珍superwoman

    ?

    0

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    2017-01-21 天水相嗝

    中国几百万颠闲病患者什么时候才能得到确切有效的治疗???

    0

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    2017-01-21 ren1mw

    继续学习,学习一下,学习中

    0

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