| 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(χ2 = 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。 |
| 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 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2023.12.010 |
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| 基金项目: |
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| COX Regression Analysis on Treatment Efficacy and Prognostic Factors of Methylprednisolone Pulse Therapy in Children with Electrical Status Epilepticus during Sleep |
| Wang Yun1 , Lu Guangshuang2 , Cheng Yun2 , Lu Xiaoyan2 , Yang Wu1, 2 |
| (1. Bengbu Medical College, Anhui Bengbu 233030, China; 2. Lu’an Hospital of Anhui Medical University, Anhui Lu’an 237005, China) |
| Abstract: |
| 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 (χ2 = 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 electroencephalogram discharges are independent risk factors affecting the prognosis of ESES. |
| Key words: ]electrical status epilepticus during sleep methylprednisolone survival analysis prognostic factors children |
