Barbella Giuseppina, Barras Pierre, Rossetti Andrea O, Novy Jan
Neurology Service, Department of Clinical Neurosciences, CHUV, Lausanne University Hospital, Switzerland; Neurology Unit, San Gerardo Hospital, Monza, Italy; School of Medicine and Surgery and Milan-Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy.
Master of Medicine, University of Lausanne, Switzerland.
Epilepsy Res. 2020 Jul;163:106326. doi: 10.1016/j.eplepsyres.2020.106326. Epub 2020 Apr 8.
Hypophosphatemia was recently reported as a potential marker of tonic-clonic (TC) seizures among patients with transitory loss of consciousness (TLOC). Its value compared to classical markers (creatine kinase [CK] and lactate) is however unknown.
Compare the diagnostic performance of hypophosphatemia, plasma CK, and lactate levels for distinguishing TC seizures from other TLOCs, alone or in combination.
128 patients aged 18-90, consecutively admitted to our hospital emergency department for TLOC were included. Diagnostic accuracy of plasma phosphate, CK, and lactate levels were compared with ROC curves.
We found significantly higher CK (median 154 U/l, range 38-5608; vs 115.5, 37-2340 U/l; p = 0.037) and lower phosphatemia (median 0.79 mmol/l, 0.34-1.37; vs 0.93, 0.52-1.89 mmol/l, p = 0.007) in TC seizures compared to other TLOCs; lactatemia was not different, although using a smaller sample (n = 72). Hypophosphatemia was the only independent predictor of TC seizures, even in later samples (>2 h). Comparing ROC curves, Combining hypophosphatemia and hyperCKemia had higher diagnostic accuracy for TC seizures than hyper-CKemia alone (AUC 0.68, 95 % CI 0.571-0.783 vs. 0.59, 95 % CI 0.475-0.706; p = 0.018), but the combination was only marginally better than hypophosphatemia alone (AUC 0.67, 95 % CI 0.559-0.778).
Hypophosphatemia seems to be more useful than CK levels for diagnosing TC seizures in patients assessed in an emergency setting for TLOC. Combining both parameters together does not significantly increase the diagnostic yield. No conclusion could be drawn regarding the comparison with lactate. A prospective study is needed.
最近有报道称，低磷血症是短暂意识丧失（TLOC）患者强直阵挛性（TC）发作的潜在标志物。然而，与传统标志物（肌酸激酶[CK]和乳酸）相比，其价值尚不清楚。
比较低磷血症、血浆CK和乳酸水平单独或联合用于区分TC发作与其他TLOC的诊断性能。
纳入128例年龄在18 - 90岁之间、因TLOC连续入住我院急诊科的患者。通过ROC曲线比较血浆磷酸盐、CK和乳酸水平的诊断准确性。
我们发现，与其他TLOC相比，TC发作时CK显著升高（中位数154 U/l，范围38 - 5608；vs 115.5，37 - 2340 U/l；p = 0.037），而血磷降低（中位数0.79 mmol/l，0.34 - 1.37；vs 0.93，0.52 - 1.89 mmol/l，p = 0.007）；尽管样本量较小（n = 72），但乳酸血症无差异。低磷血症是TC发作的唯一独立预测因素，即使在后期样本（>2小时）中也是如此。比较ROC曲线，低磷血症和高CK血症联合对TC发作的诊断准确性高于单独高CK血症（AUC 0.68，95%CI 0.571 - 0.783 vs. 0.59，95%CI 0.475 - 0.706；p = 0.018），但联合仅略优于单独低磷血症（AUC 0.67，95%CI 0.559 - 0.778）。
在因TLOC进行急诊评估的患者中，低磷血症在诊断TC发作方面似乎比CK水平更有用。将两个参数结合在一起并不能显著提高诊断率。关于与乳酸的比较无法得出结论。需要进行前瞻性研究。
