自身免疫性脑炎癫痫发作的危险因素以及预测价值评估

Risk factors for seizures in autoimmune encephalitis and assessment of predictive value

目的分析自身免疫性脑炎(Autoimmune encephalitis,AE)患者的癫痫发作的危险因素,并评估其对癫痫发作的预测价值。方法收集2016年1月—2023年3月于新疆医科大学第一附属医院就诊的74例AE患者,分为癫痫发作组(56例)和非癫痫发作组(18例),比较两组患者的一般临床信息、实验室检查和影像学检查等相关资料。采用多因素Logistic回归分析AE患者癫痫发作的危险因素,并通过受试者工作特征(Receiver operating characteristic,ROC)曲线评估其预测价值。结果与非癫痫发作组相比,癫痫发作组的基本人口学中的急性起病情况比例较高(P<0.05)。实验室资料中两组间中性粒细胞计数、降钙素原、乳酸脱氢酶、C反应蛋白、同型半胱氨酸和白细胞介素-6比较,差异均有统计学意义(P均<0.05)。对以上差异性指标采用多因素Logistic回归分析显示,C反应蛋白增高[比值比(Odds ratio,OR)=4.621,95%CI(1.123,19.011),P=0.034)]、高同型半胱氨酸[OR=12.309,95CI(2.217,68.340),P=0.004]和起病情况[OR=4.918,95%CI(1.254,19.228),P=0.022]是AE患者癫痫发作的危险因素,三项指标联合预测AE患者癫痫发作的ROC曲线下面积为0.856[95%CI(0.746,0.966)],敏感度为73.2%,特异度为83.3%。结论高C反应蛋白、高同型半胱氨酸和急性起病是AE患者癫痫发作的独立危险因素,三项指标联合可较好地预测患者的癫痫发作状况。

Objective To analyze the risk factors for seizures in patients with autoimmune encephalitis(AE)and to assess their predictive value for seizures.Methods Seventy-four patients with AE from the First Affiliated Hospital of Xinjiang Medical University from January 2016 to March 2023 were collected and divided into seizure group(56 cases)and non-seizure group(18 cases),comparing the general clinical information,laboratory tests and imaging examinations and other related data of the two groups.The risk factors for seizures in AE patients were analyzed by multifactorial logistic regression,and their predictive value was assessed by receiver operating characteristic(ROC)curves.Results The seizure group had a higher proportion of acute onset conditions in the underlying demographics compared with the nonseizure group(P<0.05).Laboratory data showed statistically significant differences in neutrophil count,calcitoninogen,lactate dehydrogenase,C-reactive protein,homocysteine,and interleukin-6 compared between the two groups(all P<0.05).Multi-factor logistic regression analysis of the above differential indicators showed that increased C-reactive protein[Odds ratio(OR)=4.621,95%CI(1.123,19.011),P=0.034],high homocysteine[OR=12.309,95CI(2.217,68.340),P=0.004]and onset of disease[OR=4.918,95%CI(1.254,19.228),P=0.022]were risk factors for seizures in AE patients,and the area under the ROC curve for the combination of the three indicators to predict seizures in AE patients was 0.856[95%CI(0.746,0.966)],with a sensitivity of 73.2%and a specificity of 83.3%.Conclusion High C-reactive protein,high homocysteine and acute onset are independent risk factors for seizures in patients with AE,and the combination of the three indices can better predict seizure status in patients.