儿童非惊厥性癫痫持续状态临床特征、脑电图特点及其对脑功能预后的影响

Clinical characteristics and electroencephalogram characteristics of children with nonconvulsive status epilepticus and their influence on the prognosis of brain function

目的 探究儿童非惊厥性癫痫持续状态的临床特征和脑电图特点及其对脑功能预后的影响。方法 选取2017年1月至2020年12月就诊的非惊厥性癫痫持续状态(NCSE)患儿116例,采集受试者的临床资料和脑电图检查结果,根据受试者出院时的脑功能评价作为预后,比较预后良好组和预后不良组患儿的临床资料,将有差异的因素纳入Logistic多因素回归分析,并构建Nomogram预后预测模型,通过受试者操作特征(ROC)曲线和校准曲线对预测模型进行评价。结果 预后良好组和预后不良组患儿间临床资料比较分析结果显示,预后不良组发育落后、脑电图分级为3~6级、发作持续时间长的患者比例高于预后良好组,全面性发作的患者比例低于预后良好组,差异具有统计学意义(P<0.05)。影响NCSE患儿脑功能后的多因素分析结果显示存在发育落后、脑电图分级为3~6级、发作持续时间≥1 h是NCSE患儿脑功能预后的危险因素,存在全面性发作是保护因素(P<0.05)。将以上因素构建得到Nomogram预后风险模型,进行ROC曲线分析和校准曲线分析,结果显示模型具有较好的区分度和校准度。结论 通过对NCSE患儿进行临床资料收集和脑电图检查,对患儿脑功能预后有预测价值,有助于改善患儿预后。

Objective To explore the clinical and electroencephalogram features of children with nonconvulsive status epilepticus and their impact on the prognosis of brain function. Methods A total of 116 children with nonconvulsive status epilepticus(NCSE) who were treated from January 2017 to December 2020 were selected, and the clinical data and EEG examination results of the subjects were collected, and the brain function evaluation at the time of discharge was used as the prognosis, and the clinical data of the children with good prognosis and poor prognosis were compared, and the different factors were included in the Logistic multivariate regression analysis, and the Nomogram prognosis prediction model was constructed, and the prediction model was evaluated by receiver operating characteristic(ROC) curve and calibration curve.Results The results of the comparative analysis of clinical data between the children in the good prognosis group and the poor prognosis group showed that the proportion of patients with delayed development, EEG grade 3~6, and long seizure duration in the poor prognosis group was higher than that in the good prognosis group, and the proportion of patients with generalized seizures was lower than that in the good prognosis group, and the difference was statistically significant(P<0.05). The results of multivariate analysis after affecting the brain function of NCSE children showed that developmental delay, EEG grade 3~6,and seizure duration ≥1 h were risk factors for the prognosis of brain function in children with NCSE, and the presence of generalized seizures was a protective factor(P<0.05). The above factors were constructed to obtain the Nomogram prognostic risk model, and the ROC curve analysis and calibration curve analysis were carried out. The results showed that the model had a good degree of discrimination and calibration. Conclusion The clinical data collection and EEG examination of children with NCSE have predictive value for the prognosis of children’s brain function and help to improve the prognosis of children.