个体化预测功能区癫痫患者行射频热凝毁损术中迷走神经兴奋反应的风险列线图模型的建立  

Establishment of a risk nomogram model for predicting the excitatory response of vagus nerve in patients with functional epilepsy after radiofrequency thermocoagulation

作　　者：林耀新 王国福[1] 钟旭光[1] 罗津奇 LIN Yaoxin;WANG Fu;ZHONG Xuguang;LUO Jinqi(Department of Functional Neurosurgery,Foshan First People's Hospital,Foshan 528300,China)

机构地区：[1]佛山市第一人民医院功能神经外科,佛山528300

出　　处：《癫痫杂志》2021年第4期296-301,共6页Journal of Epilepsy

基　　金：佛山市卫生和健康局医学科研课题(20190050)。

摘　　要：目的探讨个体化预测功能区癫痫患者行射频热凝毁损术中迷走神经兴奋反应的风险列线图模型的建立。方法选取2016年1月—2020年6月我院神经外科收治的功能区癫痫患者106例,根据是否发生迷走神经兴奋反应(Vagus excitatory response,VER)分为VER组与未发生VER组。利用Logistic回归分析筛选出影响功能区癫痫患者立体脑电图技术(Stereoscopic electroencephalography,SEEG)引导下的射频热凝毁损术(Percutaneous radiofrequency thermocoagulation,PRFT)术中并发VER的危险因素,并利用R软件建立影响SEEG引导下的PRFT发生VER的列线图模型,采用Bootstrap法进行内部验证,采用一致性指数(C-index)、校正曲线和ROC曲线评价模型的预测能力。结果Logistic回归分析结果显示,年龄[OR=0.235,95%CI(0.564,3.076)]、术前Fugl-Meyer评分[OR=4.356,95%CI(1.537,6.621)]、抑郁[OR=0.995,95%CI(1.068,7.404)]、病灶范围[OR=1.512,95%CI(0.073,3.453)]为SEEG引导下的PRFT发生VER的独立危险因素(P<0.05),与PRFT发生VER高度相关。基于以上6项指标建立SEEG引导下的PRFT发生VER风险的列线图模型,并对模型进行内部验证,结果显示:建模集和验证集的C-index指数分别为0.779[95%CI(0.689,0.869)]和0.782[95%CI(0.692,0.872)];两组的校正曲线均与标准曲线拟合较好;两组ROC曲线下面积(AUC)分别为0.779和0.782,证明本次模型具有良好的预测精准度。结论对于需行SEEG引导下的PRFT治疗的功能区癫痫患者,应充分考虑年龄、术前Fugl-Meyer评分、抑郁、病灶范围等因素,综合评估VER发生率,并及早采取干预措施,以降低并发生发生率,具有较好的临床应用价值。Objective To investigate the establishment of a risk nomogram model for predicting vagus excitatory response in patients with functional epilepsy after radiofrequency thermocoagulation.Methods A total of 106 patients with epilepsy admitted to the neurosurgery department of our hospital from January 2016 to June 2020 were selected and divided into the Vagus excitatory response(VER)group and the non-VER group according to their occurrence or absence.Logistic regression analysis was used to screen out the risk factors of VER during SEEG-guided Percutaneous radiofrequency thermocoagulation(PRFT)in patients with functional epilepsy,and R software was used to establish a histogram model affecting VER in SEEG-guided PRFT.Bootstrap method was used for internal verification.C-index,correction curve and ROC curve were used to evaluate the prediction ability of the model.Results Logistic regression analysis showed that age[OR=0.235,95%CI(0.564,3.076)],preoperative fugl-meyer score[OR=4.356,95%CI(1.537,6.621)],depression[OR=0.995,95%CI(1.068,7.404)],and lesion range[OR=1.512,95%CI(0.073,3.453)]were independent risk factors for the occurrence of VER in PRFT under the guidance of SEEG(P<0.05),and were highly correlated with the occurrence of VER in PRFT.Based on the above six indicators,a SEEG-guided colograph model of VER risk in PRFT was established,and the model was validated internally.The results showed that the C-index of the modeling set and validation set were 0.779[95%CI(0.689,0.869)]and 0.782[95%CI(0.692,0.872)],respectively.The calibration curves of the two groups fit well with the standard curves.The areas under the ROC curve(AUC)of the two groups were 0.779 and 0.782 respectively,which proved that the model had good prediction accuracy.Conclusion For patients with functional epilepsy requiring seeg-guided PRFT therapy,age,preoperative Fugl-meyer score,depression and lesion range should be taken into full consideration to comprehensively assess the incidence of VER,and early intervention measures should be taken to

关 键 词：功能区癫痫 射频热凝毁损术 迷走神经兴奋反应 风险模型 

分 类 号：R651.1[医药卫生—外科学]