地方性流行村庄中钙化性神经囊尾蚴病与癫痫的关系：厄瓜多尔农村地区基于计算机断层扫描的大规模人群研究
On the relationship between calcified neurocysticercosis and epilepsy in an endemic village: A large-scale, computed tomography-based population study in rural Ecuador.
作者信息
Del Brutto Oscar H, Arroyo Gianfranco, Del Brutto Victor J, Zambrano Mauricio, García Héctor H
机构信息
School of Medicine, Universidad Espiritu Santo-Ecuador, Guayaquil, Ecuador.
School of Public Health and Management, Cayetano Heredia University, Lima, Perú.
出版信息
Epilepsia. 2017 Nov;58(11):1955-1961. doi: 10.1111/epi.13892. Epub 2017 Aug 29.
OBJECTIVE
Using a large-scale population-based study, we aimed to assess prevalence and patterns of presentation of neurocysticercosis (NCC) and its relationship with epilepsy in community-dwellers aged ≥20 years living in Atahualpa (rural Ecuador).
METHODS
In a three-phase epidemiological study, individuals with suspected seizures were identified during a door-to-door survey and an interview (phase I). Then, neurologists evaluated suspected cases and randomly selected negative persons to estimate epilepsy prevalence (phase II). In phase III, all participants were offered noncontrast computed tomography (CT) for identifying NCC cases. The independent association between NCC (exposure) and epilepsy (outcome) was assessed by the use of multivariate logistic regression models adjusted for age, sex, level of education, and alcohol intake. CT findings were subsequently compared to archived brain magnetic resonance imaging in a sizable subgroup of participants.
RESULTS
Of 1,604 villagers aged ≥20 years, 1,462 (91%) were enrolled. Forty-one persons with epilepsy (PWE) were identified, for a crude prevalence of epilepsy of 28 per 1,000 population (95% confidence interval [CI] = 20.7-38.2). A head CT was performed in 1,228 (84%) of 1,462 participants, including 39 of 41 PWE. CT showed lesions consistent with calcified parenchymal brain cysticerci in 118 (9.6%) cases (95% CI = 8.1-11.4%). No patient had other forms of NCC. Nine of 39 PWE, as opposed to 109 of 1,189 participants without epilepsy, had NCC (23.1% vs. 9.2%, p = 0.004). This difference persisted in the adjusted logistic regression model (odds ratio = 3.04, 95% CI = 1.35-6.81, p = 0.007).
SIGNIFICANCE
This large CT-based study demonstrates that PWE had three times the odds of having NCC than those without epilepsy, providing robust epidemiological evidence favoring the relationship between NCC and epilepsy.
目的
通过一项基于大规模人群的研究，我们旨在评估神经囊尾蚴病（NCC）的患病率、临床表现模式及其与居住在阿塔瓦尔帕（厄瓜多尔农村）年龄≥20岁社区居民癫痫的关系。
方法
在一项三阶段的流行病学研究中，在挨家挨户的调查和访谈期间识别出疑似癫痫发作的个体（第一阶段）。然后，神经科医生对疑似病例进行评估，并随机选择阴性个体以估计癫痫患病率（第二阶段）。在第三阶段，为所有参与者提供非增强计算机断层扫描（CT）以识别NCC病例。通过使用针对年龄、性别、教育程度和酒精摄入量进行调整的多变量逻辑回归模型，评估NCC（暴露因素）与癫痫（结果）之间的独立关联。随后，在相当一部分参与者亚组中，将CT结果与存档的脑磁共振成像进行比较。
结果
在1604名年龄≥20岁的村民中，1462人（91%）被纳入研究。识别出41名癫痫患者（PWE）,癫痫粗患病率为每1000人中有28例（95%置信区间[CI]=20.7-38.2）。1462名参与者中的1228人（84%）进行了头部CT检查，包括41名PWE中的39人。CT显示118例（9.6%）病例（95%CI=8.1-11.4%）有与钙化实质脑囊尾蚴一致的病变。没有患者有其他形式的NCC。39名PWE中有9人患有NCC，而1189名无癫痫的参与者中有109人患有NCC（23.1%对9.2%，p=0.004）。在调整后的逻辑回归模型中，这种差异仍然存在（比值比=3.04，95%CI=1.35-6.81，p=0.007）。
意义
这项基于CT的大型研究表明，PWE患NCC的几率是无癫痫者的三倍，为支持NCC与癫痫之间的关系提供了有力的流行病学证据。
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