视频脑电图联合全部窦性心搏RR间期标准差对小儿癫痫的诊断价值研究

Diagnostic Value of Video EEG Combined with Standard Deviation of All Sinus Heart Beat RR Intervals in Children with Epilepsy

背景癫痫是儿童中枢神经系统常见疾病之一,既往临床采用视频脑电图(VEEG)、心率变异性单一指标诊断癫痫,而二者联合能否提高小儿癫痫的诊断正确率尚不可知。目的探讨VEEG联合全部窦性心搏RR间期标准差(SDNN)对小儿癫痫的诊断价值。方法选取2019-2020年扬州大学医学院附属沭阳医院门诊部收治的203例疑似癫痫患儿为研究对象,依据患儿临床症状及影像学监测结果将最终确诊为癫痫的128例患儿作为癫痫组,非癫痫患儿75例作为非癫痫组。比较两组患儿性别、年龄、体质量、身高、合并症、VEEG异常发生率及心率变异性指标。分析癫痫患儿VEEG情况,并绘制受试者工作特征(ROC)曲线以评估VEEG、SDNN及二者联合对小儿癫痫的诊断价值。结果癫痫组患儿VEEG异常发生率高于非癫痫组,SDNN低于非癫痫组(P<0.05)。癫痫患儿VEEG监测结果显示,103例表现为痫样放电,异常率为80.47%。ROC曲线分析结果显示,VEEG诊断小儿癫痫的曲线下面积(AUC)为0.746〔95%CI(0.702,0.812)〕,SDNN诊断小儿癫痫的AUC为0.713〔95%CI(0.654,0.774)〕,VEEG联合SDNN诊断小儿癫痫的AUC为0.859〔95%CI(0.819,0.905)〕。VEEG联合SDNN诊断小儿癫痫的AUC分别高于VEEG、SDNN诊断小儿癫痫的AUC(P<0.05)。结论针对VEEG出现痫样放电者需警惕癫痫的发生,VEEG联合SDNN对小儿癫痫具有较高的诊断价值。

Background Epilepsy is one of the common diseases of the central nervous system in children.In the past,there had been studies on the diagnosis of epilepsy by using a single index of video EEG(VEEG)and heart rate variability,but it is still unknown whether the combination of the two can improve the diagnostic value of epilepsy in children.Objective To explore the diagnostic value of VEEG combined with standard deviation of all sinus heart beat RR intervals(SDNN)in children with epilepsy.Methods A total of 203 children with suspected epilepsy in Outpatient Department of Shuyang Hospital,Yangzhou University Medical College from 2019 to 2020 were selected as the research objects.One hundred twenty-eight cases who were finally diagnosed epilepsy as epilepsy group and 75 cases who were finally diagnosed non-epilepsy as non-epilepsy group according to the clinical symptoms and imaging monitoring results of children.Gender,age,weight,height,complications,VEEG abnormal rate and heart rate variability indexes were compared between the two groups,and the VEEG were analysed of children with epilepsy.Receiver operating characteristic(ROC)curve was drawn to evaluate diagnostic value of VEEG combined with SDNN in children with epilepsy.Results VEEG abnormal rate in epilepsy group was higher than that in non-epilepsy group,SDNN was lower than that in non-epilepsy group(P<0.05).The VEEG monitoring results of children with epilepsy showed that,103 cases showed epileptiform discharges,with an abnormal rate of 80.47%.ROC curve analysis showed that,the area under curve(AUC)of VEEG,SDNN and the combination in the disgnosis of children with epilepsy was 0.746[95%CI(0.702,0.812)],0.713[95%CI(0.654,0.774)],0.859[95%CI(0.819,0.905)],respectively.AUC of VEEG combined with SDNN in the disgnosis of children with epilepsy was higher than that of VEEG,SDNN(P<0.05).Conclusion The patients with epileptiform discharges in VEEG need to be alert to epilepsy,and VEEG combined with SDNN has high diagnostic value for children with epilepsy.