摘要
目的探讨出血性卒中(intracerebral hemorrhage,ICH)患者迟发癫痫的独立危险因素并构建简易预测模型,为临床早期识别高风险患者提供依据。方法选取2022年1月至2024年12月开封市中心医院神内重症医学科收治的322例ICH患者为研究对象。收集患者的人口学特征和临床资料,单因素分析其出院后发生迟发癫痫的相关因素,多因素logistic回归分析确定独立危险因素,构建迟发癫痫的风险预测模型,以受试者工作特征(receiver operating characteristic,ROC)曲线和Hosmer-Lemeshow检验评估模型的预测效能。结果322例ICH患者中,迟发癫痫患者30例(9.32%)。ICH至首次癫痫发作的平均时间为(45.47±13.31)d,27例(90%)ICH患者接受抗癫痫药物(丙戊酸钠51.85%,左乙拉西坦33.33%)治疗。脑叶出血、血肿体积增大及手术治疗是迟发癫痫的独立危险因素,年龄增长为保护因素,据此构建回归方程。模型方程:logit(P)=-3.872+1.447×脑叶出血+0.077×血肿体积+1.633×手术治疗-0.163×年龄。曲线下面积(area under curve,AUC)为0.783(95%CI:0.708~0.858),敏感度为77.28%,特异度为78.52%;校准度良好(χ^(2)=4.130,P=0.486)。结论脑叶出血、血肿体积、手术治疗和年龄是ICH患者发生迟发癫痫的重要影响因素,该四变量模型可快速识别ICH后迟发癫痫的高危患者,利于早期干预。
Objective To investigate the risk factors of delayed epilepsy in patients with hemorrhagic stroke and establish a simple prediction model,providing a basis for early identification of high-risk patients in clinical practice.Methods A total of 322 patients with hemorrhagic stroke were selected as research subjects from Neurointensive Care Unit,Department of Neurology at Kaifeng Central Hospital from January 2022 to December 2024.The patients were collected for their demographic and clinical data.Univariate analysis was performed to screen the factors-related to developing delayed epilepsy after discharge.Multivariate logistic regression analysis was used to identify independent risk factors for establishing a risk prediction model for delayed epilepsy.Predictive performance of the model was evaluated using receiver operating characteristic(ROC)curve and Hosmer Lemeshow test.Results Among 322 patients with hemorrhagic stroke,there were 30 patients(9.32%)with delayed epilepsy.The average time from hemorrhagic stroke to the first onset of seizure was(45.47±13.31)days,and 27 patients with hemorrhagic stroke(90%)received treatment with antiepileptic drugs(51.85%with sodium valproate,33.33%with levetiracetam).Lobar hemorrhage,hematoma volume increase and surgical treatment were independent risk factors for delayed epilepsy,while age increase was a protective factor.Model equation:logit(P)=-3.872+1.447×cerebral hemorrhage+0.077×hematoma volume+1.633×surgical treatment-0.163×age.The area under ROC curve(AUC)was 0.783(95%CI:0.708~0.858),with a sensitivity of 77.28%and a specificity of 78.52%.The calibration test result was good(χ^(2)=4.130,P=0.486).Conclusion Lobar hemorrhage,hematoma volume,surgical treatment and age are important influencing factors for developing delayed epilepsy in patients with hemorrhagic stroke.This four-variable model may quickly identify high-risk patients with delayed epilepsy after hemorrhagic stroke,which is beneficial for early intervention.
作者
牛媛媛
王秀庆
姬玉冰
NIU Yuanyuan;WANG Xiuqing;JI Yubing(Neurointensive Care Unit,Department of Neurology,Kaifeng Central Hospital,Kaifeng(475001),Henan,China)
出处
《癫痫与神经电生理学杂志》
2025年第5期286-291,共6页
Journal of Epileptology and Electroneurophysiology
