多变量分析天气和空气污染对儿童无诱因癫痫发作急诊就诊的影响：回顾性临床观察研究。

Multivariate analysis of the impact of weather and air pollution on emergency department visits for unprovoked seizure among children: A retrospective clinical observational study.

机构信息

Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.

出版信息

Epilepsy Behav. 2021 Dec;125:108434. doi: 10.1016/j.yebeh.2021.108434. Epub 2021 Nov 24.

DOI:10.1016/j.yebeh.2021.108434

PMID:34837841

Abstract

BACKGROUND

An unprovoked seizure is a seizure or a cluster of seizures occurring within 24 h in a patient older than 1 month of age without precipitating factors. Recent studies have reported that extrinsic factors, such as meteorological conditions and air pollutants, may be important in seizure occurrence. Thus, this study aimed to examine the association between the number of visits to the emergency department (ED) by children for nighttime unprovoked seizures and exposure to multi-faceted factors, such as meteorological conditions and air pollution.

METHODS

We conducted a clinical observational analysis and reviewed consecutive patients younger than 16 years of age who visited the primary ED center in Kobe City, Japan, during nighttime (7:30 p.m.-7:00 a.m.) between January 1, 2011 and December 31, 2015. We investigated the effects of meteorological factors and air pollutants on the number of patients with unprovoked seizures using multivariate analysis of Poisson regression estimates.

RESULTS

In total, 151,119 children visited the ED, out of which 97 patients presented with unprovoked seizures. The mean age of the patients was 4.7 years (range, 1 month to 15.3 years), and 54.6% of them were boys. The total number of patients with unprovoked seizures showed no significant changes with the seasons; however, there were dominant peaks during the fall and fewer visits during the summer. The multivariate analysis of Poisson regression estimates revealed a significant positive relationship between the number of patients presenting with unprovoked seizures and precipitation (+1 patient/87 mm; p = 0.03) and methane (+1 patient/0.14 ppm; p = 0.03) levels and a negative relationship between the number of patients presenting with unprovoked seizures and nitrogen dioxide level (-1 patient/0.02 ppm; p = 0.04).

CONCLUSIONS

The present study is the first to evaluate the association between the number of children who presented to the ED with nighttime unprovoked seizures and environmental factors after controlling for confounding factors.

摘要

背景

无诱因发作是指在 1 个月以上的患者中，24 小时内出现一次或多次发作，无诱发因素。最近的研究表明，气象条件和空气污染物等外在因素可能在发作中起重要作用。因此，本研究旨在检查儿童夜间无诱因发作就诊次数与气象条件和空气污染等多方面因素暴露之间的关系。

方法

我们进行了临床观察性分析，回顾了 2011 年 1 月 1 日至 2015 年 12 月 31 日期间，在日本神户市主要急诊中心夜间（晚上 7:30 至早上 7:00）就诊的年龄小于 16 岁的连续患者。我们使用多元 Poisson 回归估计分析气象因素和空气污染物对无诱因发作患者数量的影响。

结果

共有 151119 名儿童就诊于 ED，其中 97 名患有无诱因发作。患者的平均年龄为 4.7 岁（范围，1 个月至 15.3 岁），其中 54.6%为男孩。无诱因发作患者总数无明显季节性变化，但秋季就诊人数较多，夏季就诊人数较少。多元 Poisson 回归估计分析显示，无诱因发作患者数量与降水（每增加 87mm 增加 1 名患者；p=0.03）和甲烷（每增加 0.14ppm 增加 1 名患者；p=0.03）水平呈显著正相关，与二氧化氮水平呈显著负相关（每减少 0.02ppm 减少 1 名患者；p=0.04）。