儿童热性惊厥日后癫痫发作的危险因素及列线图预测模型构建

李清峰; 刘欢; 董改琴

doi:10.16766/j.cnki.issn.1674-4152.003337

儿童热性惊厥日后癫痫发作的危险因素及列线图预测模型构建

doi: 10.16766/j.cnki.issn.1674-4152.003337

扬州大学附属医院儿科，江苏扬州 225000

基金项目:

江苏省卫生健康委员会基金资助项目 M2021076

详细信息

通讯作者:
董改琴，E-mail：donggaiqin@126.com

中图分类号: R729 R742.1
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出版历程
- 收稿日期: 2023-01-20
- 网络出版日期: 2024-03-09

Risk factors for epileptic seizures after febrile seizures in children and construction of a nomogram prediction model

Department of Pediatrics, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu 225000, China

摘要

摘要: 目的分析儿童热性惊厥日后癫痫发作的危险因素，并构建个体化预测癫痫发作的列线图模型。方法选取扬州大学附属医院2019年9月—2022年10月期间296例热性惊厥儿童为研究对象，根据惊厥日后是否癫痫发作分为癫痫组(54例)和非癫痫组(242例)。经单因素及多因素logistic回归分析确定儿童热性惊厥日后癫痫发作的影响因素，采用R语言软件包建立预测儿童热性惊厥日后癫痫发作的列线图模型，绘制校准曲线及ROC曲线评估列线图模型的预测效果。结果癫痫组初次发作年龄为3个月~1岁、首次惊厥次数≥4次、复杂性热性惊厥、有脑电图异常、有癫痫家族史比例均显著高于非癫痫组(P＜0.05)。初次发作年龄为3个月~1岁(OR=3.425，P＜0.05)、首次惊厥次数≥4次(OR=2.974，P＜0.05)、复杂性热性惊厥(OR=4.621，P＜0.05)、有脑电图异常(OR=2.836，P＜0.05)、有癫痫家族史(OR=5.572，P＜0.05)均为影响儿童热性惊厥日后癫痫发作的独立危险因素。校准曲线趋近于理想曲线，列线图模型预测儿童热性惊厥日后癫痫发作的预测值与实际值基本一致。ROC曲线下面积为0.896(95% CI：0.851~0.940)，预测效能中等。结论本研究基于多因素logistic回归分析构建的预测模型可较好地预测儿童热性惊厥日后癫痫发作，对防治癫痫发作有一定的指导意义。
- 热性惊厥 /
- 儿童 /
- 癫痫发作 /
- 危险因素 /
- 列线图预测模型
Abstract: Objective To analyze the risk factors for epileptic seizures in children after febrile seizures and to develop an individual nomograph model to predict epileptic seizures. Methods A total of 296 children with febrile seizures in the Department of Pediatrics, Affiliated Hospital of Yangzhou University from September 2019 to October 2022 were selected as study subjects, the patients were divided into epileptic group (54 cases) and nonepileptic group (242 cases) according to whether they had epileptic seizure after the day of seizure. The factors influencing epileptic seizures in children after febrile seizure were determined by single-factor and multiple-factor logistic regression analyses, a nomogram model was constructed using the R language software package to predict seizures after febrile seizure in children, and a calibration curve and ROC curve were drawn to evaluate the predictive ability of the nomogram model. Results The proportions of patients with the age of first seizure between 3 months and 1 year, number of first seizures ≥ 4 times, complex febrile seizures, abnormal electroencephalogram (EEG) and family history of epilepsy in the epileptic group were significantly higher than those in the nonepileptic group (P < 0.05). Age of first seizure between 3 months and 1 year (OR=3.425, P < 0.05), number of first seizures ≥ 4 times (OR=2.974, P < 0.05), complex febrile seizures (OR=4.621, P < 0.05), abnormal EEG (OR=2.836, P < 0.05) and family history of epilepsy (OR=5.572, P < 0.05) were all independent risk factors for epileptic seizure after febrile seizure in children. The calibration curve was close to the ideal curve, and the predictive value of the nomogram model for predicting epileptic seizures after febrile seizure in children was basically in agreement with the actual value. The area under the ROC curve was 0.896 (95% CI: 0.851-0.940), indicating moderate predictive efficiency. Conclusion The prediction model based on multifactor logistic regression analysis in this study can better predict seizures after childhood febrile seizures, and has some guidance on prevention and treatment of seizures.
- Febrile seizure /
- Children /
- Epilepsy /
- Risk factors /
- Nomogram prediction model

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图 1 预测儿童热性惊厥日后癫痫发作的列线图模型

Figure 1. The nomograph model for predicting the future seizures of children with febrile seizures

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图 2 列线图模型预测儿童热性惊厥日后癫痫发作的校准曲线

Figure 2. Calibration curve of nomograph model for predicting seizures in children after febrile seizures

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图 3 列线图模型预测儿童热性惊厥日后癫痫发作的ROC曲线

Figure 3. ROC curve of the nomograph model for predicting seizures in children after febrile seizures

下载: 全尺寸图片幻灯片

表 1 儿童热性惊厥日后癫痫发作的单因素分析[例(%)]

Table 1. Single factor analysis of seizures after febrile seizures in children[cases (%)]

项目	非癫痫组(n=242)	癫痫组(n=54)	χ²值	P值
初次发作年龄			20.926	＜0.001
3个月~1岁	80(33.06)	36(66.67)
＞1~3岁	162(66.94)	18(33.33)
性别			0.028	0.867
男	133(54.96)	29(53.70)
女	109(45.04)	25(46.30)
病因			0.521	0.771
急性支气管炎	30(12.40)	8(14.81)
上呼吸道感染	186(76.86)	39(72.22)
急性肠胃炎	26(10.74)	7(12.97)
发病季节			2.160	0.540
春	16(6.61)	6(11.11)
夏	15(6.20)	4(7.41)
秋	63(26.03)	16(29.63)
冬	148(61.16)	28(51.85)
体温			0.071	0.790
＜39 ℃	157(64.88)	34(62.96)
≥39 ℃	85(35.12)	20(37.04)
首次惊厥次数			16.795	＜0.001
＜4次	146(60.33)	16(29.63)
≥4次	96(39.67)	38(70.37)
首次惊厥前发热时间			1.306	0.253
＜24 h	155(64.05)	39(72.22)
≥24 h	87(35.95)	15(27.78)
惊厥类型			31.521	＜0.001
单纯热性惊厥	163(67.36)	14(44.44)
复杂性热性惊厥	79(32.64)	40(74.07)
脑电图异常			20.386	＜0.001
无	136(56.20)	12(22.22)
有	106(43.80)	42(77.78)
热性惊厥家族史			0.726	0.394
无	199(82.23)	47(87.04)
有	43(17.77)	7(12.96)
癫痫家族史			48.430	＜0.001
无	208(85.95)	23(42.59)
有	34(14.05)	31(57.41)
围产期异常			0.107	0.744
无	180(74.38)	39(72.22)
有	62(25.62)	15(27.78)
惊厥持续时间			2.246	0.134
＜20 min	173(71.49)	33(61.11)
≥20 min	69(28.51)	21(38.89)

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表 2 儿童热性惊厥日后癫痫发作的多因素logistic回归分析

Table 2. Multivariate logistic regression analysis of seizures after febrile seizures in children

变量	B	SE	Waldχ²	P值	OR值	95% CI
初次发作年龄	1.231	0.208	35.032	＜0.001	3.425	2.278~5.149
首次惊厥次数	1.090	0.281	15.044	＜0.001	2.974	1.715~5.159
惊厥类型	1.531	0.240	40.673	＜0.001	4.621	2.887~7.397
脑电图异常	1.042	0.304	11.758	0.001	2.836	1.563~5.146
癫痫家族史	1.718	0.223	59.335	＜0.001	5.572	3.599~8.626

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