血清蛋白与惊厥性癫痫持续状态患儿氧化应激及预后的关系研究

Study on relationship between serum proteins and oxidative stress and prognosis in children with status epilepticus

目的探讨血清神经丝轻链蛋白(NfL)、颗粒蛋白前体(PGRN)、生长分化因子-15(GDF-15)水平与惊厥性癫痫持续状态(CSE)患儿氧化应激及预后的关系。方法选取2019年5月至2022年5月在赤峰市医院诊治的135例CSE患儿为CSE组,再利用格拉斯哥预后量表(GOS)评分结果将CSE患儿分为预后良好亚组(n=79,GOS评分=5分)与预后不良亚组(n=56,GOS评分<5分);另选取135例体检的健康儿童为健康组。比较CSE组与健康组血清NfL、PGRN、GDF-15、丙二醛(MDA)、超氧化物歧化酶(SOD)水平;分析CSE患儿血清NfL、PGRN、GDF-15水平与MDA和SOD的相关性;比较不同预后CSE患儿一般资料及血清NfL、PGRN、GDF-15、MDA、SOD水平;分析CSE患儿预后的影响因素,以及血清NfL、PGRN、GDF-15水平对CSE患儿预后的预测价值。结果CSE组血清NfL、PGRN、GDF-15、MDA水平均高于健康组(t值分别为33.661、7.890、41.294、16.160,P<0.05),血清SOD水平低于健康组(t=12.950,P<0.05)。CSE患儿血清NfL、PGRN、GDF-15水平与MDA均呈正相关(r值分别为0.558、0.581、0.622,P<0.05),与SOD均呈负相关(r值分别为-0.625、-0.499、-0.564,P<0.05)。预后不良亚组CSE患儿惊厥持续时间及血清NfL、PGRN、GDF-15、MDA水平均高于预后良好亚组(t值分别为8.246、10.370、9.121、11.446、7.193,P<0.05),血清SOD水平低于预后良好亚组(t=7.774,P<0.05)。多因素Logistic回归分析显示,惊厥持续时间(OR=1.112)、NfL(OR=1.038)、PGRN(OR=1.046)、GDF-15(OR=1.015)、MDA(OR=1.032)均是CSE患儿预后不良的危险因素(P<0.05),而SOD(OR=0.932)是CSE患儿预后不良的保护因素(P<0.05)。惊厥持续时间、NfL、PGRN、GDF-15、MDA、SOD预测CSE患儿预后的曲线下面积(AUC)分别为0.707、0.728、0.725、0.758、0.687、0.731;各项指标联合预测CSE患儿预后的AUC为0.881,灵敏度为0.893、特异度为0.886,诊断效能明显较高。结论CSE患儿血清NfL、PGRN、GDF-15水平与氧化应激及预后密切相关,多指标联合可较好地预测CSE患儿的预后,其可能是临床评估CSE患儿预后的潜在方法。

Objective To investigate the relationship between levels of serum neurofilament light chain protein(NfL),progranulin(PGRN),growth differentiation factor-15(GDF-15)and oxidative stress,prognosis in children with convulsive status epilepticus(CSE).Methods From May 2019 to May 2022,135 children with CSE who were diagnosed and treated in our hospital were regarded as the CSE group.Using the glasgow outcome scale(GOS)evaluation results,CSE patients were divided into subgroups with good prognosis(n=79,GOS score=5 points)and subgroups with poor prognosis(n=56,GOS score<5 points).Another 135 healthy children were regarded as the healthy group.The levels of serum NfL,PGRN,GDF-15,malondialdehyde(MDA)and superoxide dismutase(SOD)were compared between the CSE group and the healthy group.The relationship between the levels of serum NfL,PGRN,GDF-15 and MDA and SOD in children with CSE was analyzed.The general data and the levels of serum NfL,PGRN,GDF-15,MDA and SOD in children with CSE with different prognosis were compared.The influencing factors of prognosis of children with CSE were analyzed.The predictive value of serum NfL,PGRN and GDF-15 in the prognosis of children with CSE was analyzed.Results The levels of serum NfL,PGRN,GDF-15 and MDA in the CSE group were higher than those in the healthy group(P<0.05),and the level of SOD was lower than that in the healthy group(P<0.05).The levels of serum NfL,PGRN and GDF-15 in children with CSE were positively correlated with MDA(P<0.05),and negatively correlated with SOD(P<0.05).The duration of convulsion,the levels of serum NFL,PGRN,GDF-15 and MDA of children with CSE in poor prognosis subgroup were higher than those in good prognosis subgroup(P<0.05),and the level of serum SOD was lower than that in good prognosis subgroup(P<0.05).The duration of convulsion,NFL,PGRN,GDF-15 and MDA were the risk factors of poor prognosis in children with CSE(P<0.05),and SOD was the protective factor(P<0.05).The area under the curve(AUC)of duration of convulsion,NfL,PGRN,GDF-15,MDA and SOD to predict the prognosis of children with CSE was 0.707,0.728,0.725,0.758,0.687 and 0.731,respectively.The AUC of combined application to predict the prognosis of children with CSE was 0.881,and the diagnostic efficiency was significantly higher.Conclusion The levels of serum NFL,PGRN and GDF-15 in children with CSE are closely related to oxidative stress and prognosis,and the combination of multiple indicators can better predict the prognosis of children with CSE,which may be a potential method for clinical evaluation of the prognosis of children with CSE.