轻度胃肠炎伴婴幼儿良性惊厥的危险因素分析及预警模型建立

Analysis of risk factors and establishment of warning model for benign infantile convulsions associated with mild gastroenteritis

目的:探讨影响轻度胃肠炎伴良性婴幼儿惊厥(benign infantile convulsions associated with mild gastroenteritis,BICE)频发(>3次)的危险因素,建立列线图预测模型,并检验其预测能力。方法:回顾性分析江南大学附属医院2013年10月—2017年12月收治的91例BICE的临床资料,根据惊厥发作次数分为惊厥频发组(>3次)和对照组(≤3次),通过Logistic回归分析确定影响惊厥频发的危险因素,并以此构建列线图。采用受试者工作曲线(ROC)及曲线下面积(AUC)、一致性指数(C-index)、校准曲线及决策曲线分析(DCA)对列线图预测能力进行检验。结果:共纳入符合标准的BICE患儿91例,其中惊厥频发组29例,对照组62例,惊厥频发组患儿的CD4^(+)和CD8^(+)T细胞含量明显低于对照组,轮状病毒阳性率、IL-6、IL-10和TNF-α水平明显高于对照组,差异均有统计学意义(P<0.05)。轮状病毒、CD4^(+)T细胞含量、IL-10和TNF-α水平等是影响BICE患儿惊厥频发的独立危险因素(P<0.05)。将这4种变量纳入并成功构建列线图。AUC、C-index、校准曲线及DCA分析表明列线图预测效能良好,实际观测有良好的一致性。结论:依据轮状病毒、CD4^(+)T细胞含量、IL-10和TNF-α水平构建的列线图,可较准确地预测BICE患儿惊厥频发,能为临床上惊厥的管理及治疗提供参考。

Objective:This study aims to explore the risk factors that affect the frequent occurrence of convulsions(>3 times)in benign infantile convulsions associated with mild gastroenteritis(BICE),establish a nomogram prediction model,and test its predictive ability. Methods:A retrospective analysis of the clinical data of 91 cases of BICE admitted to the Department of Pediatrics of Affiliated Hospital of Jiangnan University from October 2013 to December 2017 was conducted. According to the number of convulsions,they were divided into frequent convulsions group(>3 times)and control group(≤3 times). Logistic regression analysis was used to determine the independent risk factors affecting the frequency of convulsions,and construct a nomogram. The receiver operating curve(ROC)and area under the curve(AUC),consistency index(C-index),calibration curve and decision curve analysis(DCA)were used to test the predictive ability of the nomogram. Results:A total of 91 cases with BICE who met the criteria were enrolled,including 29 in the frequent convulsions group and 62 in the control group. The content of CD4^(+)and CD8^(+)T cells in the frequent convulsions group was significantly lower than that in the control group. The positive rate of rotavirus,IL-6,IL-10 and TNF-α levels were significantly higher than those in the control group,and the differences were statistically significant(all P < 0.05). Multivariate logistic regression analysis showed that rotavirus,CD4^(+)T cell content,IL-10 and TNF-α levels were independent risk factors affecting the frequency of convulsions in cases with BICE(P < 0.05). These four independent risk factors were incorporated and a nomogram was successfully constructed. AUC,C-index,calibration curve and DCA analysis showed that the nomogram has good prediction effect,and the actual observation has good consistency. Conclusion:The reconstructed nomogram based on rotavirus,CD4^(+)T cell content,IL-10 and TNF-α levels can more accurately predict the frequency of convulsions in children with BICE,which can provide references for clinical management and treatment of convulsions.