摘要
目的 开发儿童诺如病毒急性胃肠炎多次惊厥发生风险预警系统,并对其泛化能力进行验证。方法 回顾性选取濮阳市人民医院2022年1月至2024年12月急诊科和儿科收治的196例入院前有一次惊厥史的诺如病毒急性胃肠炎患儿作为建模集,根据惊厥再发生情况分为发生组51例和未发生组145例。比较两组患儿的临床资料,采用单因素、最小绝对收缩与选择算子(LASSO)与多因素逻辑回归(Logistic)分析诺如病毒急性胃肠炎患儿多次惊厥发生的风险因素,构建风险预警系统,并采用受试者工作特征(ROC)曲线、校准曲线、决策曲线(DCA)检验风险预警系统的预测效能。另选濮阳市人民医院2025年1~5月收治的51例诺如病毒急性胃肠炎(入院前有一次惊厥史)患儿作为外部验证集进行外部验证。结果 196例诺如病毒急性胃肠炎患儿惊厥发生率为26.02%(51/196),其中发生2次占比78.43%(40/51)、>2次占比21.57%(11/51);单因素分析结果显示,发生组患儿的年龄、血钠、碳酸氢根分别为(2.89±0.94)岁、(135.00±1.96) mmol/L、(22.59±1.00) mmol/L,明显低于未发生组的(3.82±1.15)岁、(137.25±1.83) mmol/L、(23.92±1.15) mmol/L,差异均有统计学意义(P<0.05);发生组患儿的家族惊厥/癫痫史占比、拒食占比、腹泻次数、呕吐次数分别为43.14%、84.31%、(6.25±2.00)次/d、(3.84±1.15)次/d,明显高于未发生组的5.52%、62.76%、(5.19±1.68)次/d、(2.20±0.73)次/d,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,年龄、血钠升高、碳酸氢根升高是儿童诺如病毒急性胃肠炎多次惊厥发生的保护因素(P<0.05),家族惊厥/癫痫史、拒食是其多次惊厥发生的危险因素(P<0.05);基于上述影响因素建立儿童诺如病毒急性胃肠炎多次惊厥发生的风险预警系统,其一致性指数(C-index)为0.911;ROC曲线分析结果显示,该预警系统的曲线下面积(AUC)为0.911(95%CI:0.863~0.958);校准曲线显示,该预警系统的预测结果与理想曲线贴合性良好;DCA曲线显示,在阈概率0~100%时,预警系统具有正向的净获益(P<0.05);外部验证结果显示,该预警系统预测结果与临床实际的符合率为90.20%,Kappa值为0.768(P<0.05)。结论 年龄、血钠、碳酸氢根、家族惊厥/癫痫史、拒食是儿童诺如病毒急性胃肠炎多次惊厥发生的影响因素,基于上述影响因素建立的多次惊厥发生风险预警系统具有良好的预测效用及预测价值,能为临床预警多次惊厥的发生提供参考。
Objective To develop a risk warning system for multiple convulsions in children with norovirus-induced acute gastroenteritis,and to verify its generalization ability.Methods A total of 196 children with norovirus-induced acute gastroenteritis who had a history of convulsion before admission and were admitted to the Emergency Department and Department of Pediatrics,Puyang People's Hospital from January 2022 to December 2024 were retrospectively selected as the modeling set.According to the recurrence of convulsion,they were divided into the occurrence group(51 cases)and the non-occurrence group(145 cases).The clinical data of the two groups were compared.Univariate analysis,least absolute shrinkage and selection operator(LASSO),and multivariate logistic regression were used to analyze the risk factors of multiple convulsions in children with norovirus-induced acute gastroenteritis,and a risk early warning system was constructed.The receiver operating characteristic(ROC)curve,calibration curve,and decision curve(DCA)were used to test the predictive efficacy of the risk early warning system.Another 51 children with norovirus-induced acute gastroenteritis(with a history of convulsion before admission)admitted to Puyang People's Hospital from January to May 2025 were selected as the external validation set for external validation.Results The incidence of convulsion in 196 children with norovirus-induced acute gastroenteritis was 26.02%(51/196),of which two convulsions accounted for 78.43%(40/51)and more than two convulsions accounted for 21.57%(11/51).The results of univariate analysis showed that the age,serum sodium,and bicarbonate of the children in the occurrence group were(2.89±0.94)years,(135.00±1.96)mmol/L,and(22.59±1.00)mmol/L,respectively,which were significantly lower than(3.82±1.15)years,(137.25±1.83)mmol/L,and(23.92±1.15)mmol/L in the non-occurrence group(P<0.05).The proportion of children with a family history of convulsions/epilepsy,food refusal,diarrhea frequency,and vomiting frequency in the occurrence group were 43.14%,84.31%,(6.25±2.00)times/day,and(3.84±1.15)times/day,respectively,which were significantly higher than 5.52%,62.76%,(5.19±1.68)times/day,and(2.20±0.73)times/day in the non-occurrence group(P<0.05).The results of multivariate logistic regression analysis showed that age,elevated serum sodium,and elevated bicarbonate were protective factors for multiple convulsions in children with norovirus-induced acute gastroenteritis(P<0.05).Family history of convulsions/epilepsy and food refusal were risk factors for multiple convulsions(P<0.05).Based on the above influencing factors,a risk early warning system for multiple convulsions in children with norovirus-induced acute gastroenteritis was established,with a consistency index(C-index)of 0.911.The results of ROC curve analysis showed that the area under the curve(AUC)of the early warning system was 0.911(95%CI:0.8630.958).The calibration curve showed that the prediction results of this warning system were well aligned with the ideal curve.The DCA curve showed that the warning system had a positive net benefit at threshold probabilities of 0 to 100%(P<0.05).External validation results showed that the consistency rate between the prediction results of this warning system and clinical reality was 90.20%,with a Kappa value of 0.768(P<0.05).Conclusion Age,serum sodium,bicarbonate,family history of convulsions/epilepsy,and food refusal are influencing factors for the occurrence of multiple convulsions in children with norovirus-induced acute gastroenteritis.The risk warning system for multiple convulsions,established based on these influencing factors,exhibits good predictive utility and value,providing a reference for clinical early warning of multiple convulsions.
作者
段永彬
梁娟
张敬芳
胡湘萍
张俊霞
DUAN Yong-bin;LIANG Juan;ZHANG Jing-fang;HU Xiang-ping;ZHANG Jun-xia(Department of Pediatrics,Puyang People's Hospital,Puyang 457000,Henan,CHINA)
出处
《海南医学》
2026年第1期56-61,共6页
Hainan Medical Journal
基金
河南省医学科技攻关项目(编号:LHGJ20210932)。
关键词
儿童
诺如病毒
急性胃肠炎
惊厥
风险预警系统
内部验证
外部验证
Children
Norovirus
Acute gastroenteritis
Convulsions
Risk warning system
Internal verification
External verification
