复杂性热性惊厥患儿维生素D、神经胶质纤维酸性蛋白、NOD样受体蛋白3表达对继发癫痫风险的预测价值  

Predictive value of vitamin D,GFAP and NLRP3 expressions in children with complex febrile seizures for risk of secondary epilepsy

作　　者：张亚敬 谢蒙 石晶 ZHANG Yajing;XIE Meng;SHI Jing(Department of Pediatrics,Shijiazhuang People’s Hospital,Shijiazhuang 050011,China)

机构地区：[1]石家庄市人民医院儿科,河北石家庄050011

出　　处：《陕西医学杂志》2025年第3期343-348,共6页Shaanxi Medical Journal

基　　金：河北省医学科学研究课题(20241727)。

摘　　要：目的:研究复杂性热性惊厥患儿维生素D、神经胶质纤维酸性蛋白(GFAP)、NOD样受体蛋白3(NLRP3)表达对继发癫痫风险的预测价值。方法:选取200例复杂性热性惊厥患儿进行前瞻性研究,根据2年内是否继发癫痫分为癫痫组(51例)和非癫痫组(149例),比较两组临床资料、维生素D、GFAP、NLRP3 mRNA表达。采用多因素Logistic回归分析复杂性热性惊厥继发癫痫的影响因素;采用受试者工作特征(ROC)曲线分析传统方案和新型方案预测复杂性热性惊厥继发癫痫的价值;采用DeLong检验比较不同预测方案的曲线下面积(AUC)。结果:癫痫组高热惊厥/癫痫家族史占比高于非癫痫组,平均热性惊厥发作时间长于非癫痫组(均P<0.05)。癫痫组维生素D水平低于非癫痫组,GFAP、NLRP3 mRNA高于非癫痫组(均P<0.05)。高热惊厥/癫痫家族史、平均热性惊厥发作时间、维生素D、GFAP、NLRP3 mRNA是复杂性热性惊厥继发癫痫的影响因素(均P<0.05)。传统方案中,高热惊厥/癫痫家族史、平均热性惊厥发作时间单项及两项联合预测复杂性热性惊厥继发癫痫的AUC分别为0.631、0.734、0.878(均P<0.001)。新型方案中,维生素D、GFAP、NLRP3 mRNA单项及三项联合预测复杂性热性惊厥继发癫痫的AUC分别为0.790、0.774、0.784、0.909(均P<0.001)。传统方案+新型方案预测复杂性热性惊厥继发癫痫的AUC为0.914(P<0.001)。无论传统方案还是新型方案,联合预测的AUC大于单独因子(均P<0.05),且新型方案联合预测的AUC高于传统方案(P<0.05),但新型方案联合预测的AUC与传统方案+新型方案预测的AUC比较差异无统计学意义(P>0.05)。结论:复杂性热性惊厥患儿维生素D、GFAP、NLRP3表达与继发癫痫风险有关,三项联合检测时预测继发癫痫价值优于传统方案,可作为患儿病情进展的预警手段,为临床实施个性化的分层预防干预提供参考。Objective:To investigate the predictive value of vitamin D,glial fibrillary acidic protein(GFAP),and NOD-like receptor protein 3(NLRP3)expressions in children with complex febrile seizures for the risk of secondary epilepsy.Methods:A prospective study was conducted on 200 children with complex febrile convulsions.They were divided into epilepsy group(51 cases)and non-epilepsy group(149 cases)according to whether they had secondary epilepsy within 2 years.The clinical data,vitamin D,GFAP,and NLRP3 mRNA expressions were compared between the two groups.Multivariate Logistic regression analysis was used to analyze the factors affecting the secondary epilepsy of complex febrile convulsions.ROC curve was used to analyze the value of traditional and new schemes in predicting the secondary epilepsy of complex febrile convulsions.The DeLong test was used to compare the AUC values between different prediction schemes.Results:The proportion of febrile convulsions/family history of epilepsy and the average duration of febrile convulsions in the epilepsy group were higher than those in the non-epilepsy group(all P<0.05).The vitamin D level in the epilepsy group was lower than that in the non-epilepsy group,while the GFAP and NLRP3 mRNA levels were higher than those in the non-epilepsy group(all P<0.05).Family history of febrile convulsions/epilepsy,average duration of febrile convulsions,vitamin D,GFAP,and NLRP3 mRNA were independent factors associated with the development of epilepsy secondary to complex febrile convulsions(all P<0.05).In the traditional scheme,the AUCs of the family history of febrile seizures/epilepsy,the average duration of febrile seizures,and the combination of the two for predicting complex febrile seizures with secondary epilepsy were 0.631,0.734,and 0.878,respectively(all P<0.001).In the new scheme,the AUCs of vitamin D,GFAP,NLRP3 mRNA,and the combination of the three for predicting secondary epilepsy in complex febrile seizures were 0.790,0.774,0.784,and 0.909,respectively(all P<0.001).The AUC of th

关 键 词：复杂性热性惊厥 维生素D 神经胶质纤维酸性蛋白 NOD样受体蛋白3 癫痫风险 预测价值 

分 类 号：R720.597[医药卫生—急诊医学]