Department of Neurology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
Department of Neurology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
Epilepsy Behav. 2019 Oct;99:106489. doi: 10.1016/j.yebeh.2019.106489. Epub 2019 Aug 30.
Generalized tonic-clonic seizures (GTCS), syncope, and psychogenic nonepileptic seizures (PNES) are common emergent neurological conditions that cause transient disturbances of consciousness; however, it is sometimes difficult to distinguish them.
This study aimed to explore the value of serum uric acid levels in differentiating among GTCS, syncope, and PNES by analyzing serum uric acid levels in patients with GTCS, syncope, and PNES.
A total of 391 patients were retrospectively analyzed. Venous blood was drawn from the patients within 20 min of their arrival to the emergency department; serum uric acid levels were measured using the uricase method.
Serum uric acid levels and the percentage of patients with elevated uric acid (elevation percentage) were significantly higher in the group with GTCS (n = 179) than in the groups with syncope (n = 156) (p < 0.001) and PNES (n = 56) (p < 0.001). The result remained the same when the serum uric acid level of male or female patients in the group with GTCS were compared separately with that in the other two groups (all p < 0.001). In the group with GTCS, both the serum uric acid level (p < 0.001) and elevation percentage (p < 0.05) were significantly higher in males than in females. The receiver operating characteristics (ROC) analysis in male patients yielded a serum uric acid value of 428.50 μmol/L with a sensitivity of 0.78 and a specificity of 0.99 as the optimal cutoff value to distinguish GTCS from other events. In female patients, a cutoff value of 338.00 μmol/L had a sensitivity of 0.69 and a specificity of 0.91 to distinguish GTCS from other events. For the group with GTCS, the period of time between the onset of seizure and serum uric acid levels dropping to normal were analyzed in 40 patients. The duration was 44.56 ± 11.46 h for males (n = 23) and 40.37 ± 9.78 h for females (n = 17) with no significant difference (p = 0.325).
Serum uric acid levels provided certain clinical value for the differentiation of GTCS, syncope, and PNES; however, this requires verification in prospective studies with larger sample sizes.
全面性强直-阵挛发作（GTCS）、晕厥和心因性非癫痫性发作（PNES）是常见的急性神经系统疾病，可导致意识短暂障碍；然而，有时很难区分它们。
本研究旨在通过分析 GTCS、晕厥和 PNES 患者的血清尿酸水平，探讨血清尿酸水平在区分 GTCS、晕厥和 PNES 中的价值。
回顾性分析 391 例患者。患者到达急诊科后 20 分钟内采集静脉血，采用尿酸酶法测定血清尿酸水平。
GTCS 组（n=179）血清尿酸水平和尿酸升高患者百分比（升高百分比）明显高于晕厥组（n=156）（p<0.001）和 PNES 组（n=56）（p<0.001）。当分别比较 GTCS 组中男性或女性患者的血清尿酸水平与其他两组时，结果仍然相同（均 p<0.001）。在 GTCS 组中，男性的血清尿酸水平（p<0.001）和升高百分比（p<0.05）均明显高于女性。男性患者的受试者工作特征（ROC）分析得出，血清尿酸值为 428.50μmol/L，灵敏度为 0.78，特异性为 0.99，作为区分 GTCS 与其他事件的最佳截断值。在女性患者中，截断值为 338.00μmol/L 时，灵敏度为 0.69，特异性为 0.91，可区分 GTCS 与其他事件。对于 GTCS 组，对 40 例患者的癫痫发作开始到血清尿酸水平降至正常的时间进行了分析。男性（n=23）的持续时间为 44.56±11.46h，女性（n=17）的持续时间为 40.37±9.78h，无显著差异（p=0.325）。
血清尿酸水平对 GTCS、晕厥和 PNES 的鉴别具有一定的临床价值；然而，这需要在具有更大样本量的前瞻性研究中进行验证。
