儿童睡眠期电持续状态甲泼尼龙冲击治疗效果和预后影响因素的COX回归分析  

COX Regression Analysis on Treatment Efficacy and Prognostic Factors of Methylprednisolone Pulse Therapy in Children with Electrical Status Epilepticus during Sleep

作　　者：王运 陆光双 程云 卢晓燕 杨武 Wang Yun;Lu Guangshuang;Cheng Yun;Lu Xiaoyan;Yang Wu(Bengbu Medical College,Anhui Bengbu 233030,China;Lu’an Hospital of Anhui Medical University,Anhui Lu’an 237005,China)

机构地区：[1]蚌埠医学院,安徽蚌埠233030 [2]安徽医科大学附属六安医院,安徽六安237005

出　　处：《儿科药学杂志》2023年第12期44-48,共5页Journal of Pediatric Pharmacy

摘　　要：目的:探讨甲泼尼龙冲击治疗儿童睡眠期电持续状态(ESES)的疗效及影响预后的因素。方法:收集32例ESES患儿临床和随访资料,根据住院期间不同治疗方式,将纳入对象分为单用抗癫痫药物(ASM)组及甲泼尼龙+ASM组,以达到ESES临床缓解状态为阳性事件,采用Kaplan-Meier生存分析方法比较甲泼尼龙冲击联合ASM治疗和单独使用ASM治疗患儿的1年ESES临床缓解情况,并使用COX回归单因素和多因素分析,筛选ESES患儿的预后影响因素。结果:甲泼尼龙+ASM组的ESES临床缓解率6个月为58.8%(10/17),12个月为82.3%(14/17),中位缓解时间6个月(95%CI 2.975~9.025);ASM组的ESES临床缓解率6个月为20.0%(3/15),12个月为46.7%(7/15),中位缓解时间>12个月,生存分析的结果表明甲泼尼龙+ASM组中位缓解时间短于单用ASM组,差异有统计学意义,与Logrank检验结果一致(χ^(2)=5.473,P<0.05),而且甲泼尼龙+ASM组患儿认知改善更明显;多因素COX回归分析提示影像学(正常vs.异常,HR=7.994)、家族史(阴性vs.阳性,HR=5.054)、脑电图放电侧别(单侧vs.双侧,HR=2.635)是影响ESES预后的独立危险因素。结论:甲泼尼龙冲击治疗对缓解ESES患儿ESES临床发作和认知功能改善有效;影像学异常、阳性家族史及双侧脑电图放电是影响ESES预后的独立危险因素。Objective:To explore the efficacy of methylprednisolone pulse therapy in the treatment of children with electrical status epilepticus during sleep(ESES)and the factors affecting the prognosis.Methods:Clinical and follow-up data from 32 children with ESES were collected.Based on different treatment methods during hospitalization,the subjects were divided into the anti-seizure medication(ASM)group and methylprednisolone+ASM group.In order to make clinical relief of ESES be considered as a positive event,Kaplan-Meier survival analysis was used to compare the one-year clinical relief of ESES in children treated with methylprednisolone pulse therapy in combination with ASM and those treated with ASM alone.Single-factor and multi-factor COX regression analysis were used to identify prognostic factors for children with ESES.Results:In the methylprednisolone+ASM group,the clinical relief rate of ESES was 58.8%(10/17)at 6 months and 82.3%(14/17)at 12 months,with a median relief time of 6 months(95%CI from 2.975 to 9.025).In the ASM group,the clinical relief rate of ESES was 20.0%(3/15)at 6 months and 46.7%(7/15)at 12 months,with a median relief time of>12 months.Survival analysis showed that the median relief time for children in the methylprednisolone+ASM group was shorter than that for children in the ASM group,the difference was statistically significant,which was consistent with the Logrank test results(χ^(2)=5.473,P<0.05).Moreover,children in the methylprednisolone+ASM group showed more significant cognitive improvement.Multi-factor COX regression analysis indicated that imaging findings(normal vs.abnormal,HR=7.994),family history(negative vs.positive,HR=5.054),and electroencephalogram discharge laterality(unilateral vs.bilateral,HR=2.635)were independent risk factors affecting the prognosis of ESES.Conclusion:Methylprednisolone pulse therapy is effective in relieving electro-clinical seizures and improving cognitive function in children with ESES.Imaging abnormalities,positive family history and bilateral electroen

关 键 词：睡眠期电持续状态 甲泼尼龙 生存分析 预后影响因素 儿童 

分 类 号：R748[医药卫生—神经病学与精神病学]