癫痫患者初始单药治疗失败的预测量表构建——单中心真实世界研究  

A study of a predictive score system about monotherapy failure in initial epilepsy patients——a single center real world research

作　　者：李亚萍 陈茹[1] 张忱[1] 阳衡[1] 郑文[1] 宋治[1] LI Yaping;ZHANG Chen;CHEN Ru;ZHENG Wen;YANG Heng;SONG Zhi(Department of neurology,The Third Xiangya Hospital Central South University,Changsha 421001,China)

机构地区：[1]中南大学湘雅三医院神经内科,长沙421001

出　　处：《癫痫杂志》2021年第4期302-308,共7页Journal of Epilepsy

基　　金：国家自然科学基金(81671296)。

摘　　要：目的探索制订预测癫痫患者初始单药治疗失败的评分量表,以评价初始单药治疗失败的风险,为尽早联合用药治疗提供依据。方法回顾性分析2019年1月—2020年7月中南大学湘三医院神经内科收治的189例初始接受单药治疗的癫痫患者的临床资料,根据其药物方案及药物疗效分为单药治疗有效组和单药治疗失败组,应用单因素分析和二元Logistic回归分析筛选出独立危险因素,并根据方程中β值对其赋值,构建评分量表。用绘制受试者工作曲线(ROC曲线)评估量表的有效性,并划定界点值,评价量表的效度。结果以观察期内发作减少75%为判断标准,138例(73%)采用单药治疗方案有效,51例(27%)单药治疗失败。回归分析显示,有多种形式发作、癫痫持续状态(T2)、脑损害以及治疗前发病次数≥7次作为单药治疗失败的独立危险因素。由上述独立危险因素所构建评分量表总分为12分。以6分为界点值,其ROC曲线下面积为0.779,灵敏度0.314;特异度0.957,可用于初始单药治疗失败预测判断。结论该评分表可以有效评估癫痫患者初始单药治疗失败的风险,为尽早使用联合抗癫痫药物治疗方案提供依据。Objective To develop a score system to predict the probability of failure of monotherapy in epilepsy patients with initial treatment,and then provide pillars for early use of polytherapy.Methods This is a retrospective analysis of the clinical data of 189 patients with epilepsy treated in Department of Neurology,the Third Xiangya Hospital of Central South University from January 2019 to July 2020.Patients was divided into monotherapy acceptable group and monotherapy poor effect group according to their drug treatment plan and drug efficacy.The influencing factors were screened out by single factor analysis and binary logistic regression analysis.And on the basis of thisβvalue,a quantitative scoring table for predicting the unsatisfying treatment effect of monotherapy is developed.And the receiver operating curve(ROC curve)was used to evaluate the effectiveness of the scale.Results Based on a standard of 75%reduction in seizures during the observation period,138 cases(73%)were effective with monotherapy plan,while 51 cases(23%)were unsatisfactory.Regression analysis showed that multiple forms of seizures,status epilepticus(t2),brain damage,and the number of seizures≥7 times before treatment are independent risk factors for poor outcome of monotherapy.The resulting score sheet has a total score of 12 points;the area under the ROC curve is 0.779,and the critical score is 6 points(sensitivity:0.314;specificity:0.957).Patients with more than this score have a strong probability of poor response in monotherapy.Conclusion This prediction model can effectively assess the risk of unsatisfactory therapeutic effect of monotherapy in epilepsy patients who are initially treated,and thus has reference function for the early selection of polytherapy.

关 键 词：癫痫治疗 单药治疗失败 药物联合治疗 预测评分表 

分 类 号：R742.1[医药卫生—神经病学与精神病学]