Analysis in risk factors of postoperative recurrence of patients with refractory epilepsy and establishment of a risk prediction model
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摘要:目的
探讨难治性癫痫患者术后复发的危险因素并构建预测模型。
方法回顾性收集2021年6月—2022年10月在本院接受外科手术治疗的280例难治性癫痫患者的临床资料，术后均随访1年。根据复发情况分为未复发组238例和复发组42例。难治性癫痫患者术后复发的危险因素采用单因素、多因素Logistic回归分析法分析; 绘制受试者工作特征(ROC)曲线分析预测模型对难治性癫痫患者术后复发的预测价值。
结果多因素Logistic回归分析结果显示，病程>5年、术前病灶定位与手术部位不完全一致、血清维生素B6水平低、血清单核细胞趋化蛋白-1(MCP-1)水平高均是难治性癫痫术后复发的危险因素(OR=2.705、2.314、1.790、2.284, P＜0.05)。构建回归模型并按照预测概率logit(P)绘制难治性癫痫术后复发的ROC曲线，当logit(P)＞14.52时，曲线下面积(AUC)为0.850, 敏感度为78.57%, 特异度为80.67%。
结论难治性癫痫患者经外科手术治疗后复发的危险因素包括病程>5年、术前病灶定位与手术部位不完全一致、血清维生素B6水平低、血清MCP-1水平高，据此构建的难治性癫痫术后复发的回归模型预测价值较高，可对术后复发的高危群体进行针对性干预，降低其复发风险。
Abstract:ObjectiveTo explore the risk factors for postoperative recurrence in patients with refractory epilepsy and establish a predictive model.
MethodsClinical materials of 280 refractory epilepsy patients with surgical treatment in the hospital from June 2021 to October 2022 were retrospectively collected, with a follow-up of one year after surgery. These patients were divided into non-recurrence group with 238 cases and recurrence group with 42 cases according to their recurrence status. The risk factors for postoperative recurrence in refractory epilepsy patients were analyzed by univariate and multivariate Logistic regression analyses; the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of the model for postoperative recurrence in refractory epilepsy patients.
ResultsMultivariate Logistic regression analysis showed that disease duration exceeding 5 years, incomplete concordance between the preoperative localization of the lesion and thesurgical site, low serum vitamin B6 level, and high level of serum monocyte chemoattractant protein-1 (MCP-1) were the significant risk factors for postoperative recurrence in refractory epilepsy patients (OR=2.705, 2.314, 1.790 and 2.284, P < 0.05). A regression model was built based on these findings, and an ROC curve for predicting postoperative recurrence in refractory epilepsy patients was plotted based on the predicted probability logit(P). When logit(P) exceeded 14.52, the area under the curve (AUC) was 0.850, with a sensitivity of 78.57% and a specificity of 80.67%.
ConclusionIn refractory epilepsy patients with surgical treatment, disease duration exceeding 5 years, incomplete concordance between the preoperative localization of the lesion and the surgical site, low serum vitamin B6 level, and elevated MCP-1 level are identified as risk factors for postoperative recurrence. The established regression model for predicting postoperative recurrence in refractory epilepsy patients demonstrates a high predictive value, and can be utilized to identify populations with high-risk of recurrence and guide targeted interventions to reduce the risk of recurrence.
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Keywords:
- refractory epilepsy /
- surgery /
- recurrence /
- risk factors /
- prediction model /
- intervention strategies
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表 1 难治性癫痫外科手术后复发的单因素分析(x±s)[n(%)]
因素 分类 未复发组(n=238) 复发组(n=42) χ2/t P 性别 男 125(52.52) 22(52.38) 0 0.987 女 113(47.48) 20(47.62) 病程 >5年 66(27.73) 28(66.67) 24.268 < 0.001 ≤5年 172(72.27) 14(33.33) 吸烟史 有 108(45.38) 21(50.00) 0.307 0.580 无 130(54.62) 21(50.00) 家族史 有 159(66.81) 29(69.05) 0.081 0.776 无 79(33.19) 13(30.95) 术前病灶定位与手术部位的一致性 完全一致 167(70.17) 16(38.10) 16.219 < 0.001 不完全一致 71(29.83) 26(61.90) 发作类型 单纯部分性发作 132(55.46) 18(42.86) 2.281 0.131 全身强直性发作 106(44.54) 24(57.14) 术后水肿 是 90(37.82) 28(66.67) 12.088 < 0.001 否 148(62.18) 14(33.33) 手术切除程度 部分 87(36.55) 31(73.81) 20.321 < 0.001 完全 151(63.45) 11(26.19) 血清维生素B6/(nmol/L) 53.18±6.74 45.29±6.08 7.073 < 0.001 血清单核细胞趋化蛋白-1/(ng/L) 73.16±5.29 81.39±6.47 8.933 < 0.001 
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表 2 赋值情况
自变量 赋值 病程 >5年=1, ≤5年=0 术前病灶定位与手术部位一致性 不完全一致=1, 一致=0 术后水肿 是=1, 否=0 手术切除程度 部分=1, 完全=1 血清维生素B6水平 原值输入 血清单核细胞趋化蛋白-1水平 原值输入
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表 3 难治性癫痫外科手术后复发的多因素Logistic回归分析
影响因素 β SE Wald χ2 P OR 95%CI 病程>5年 0.995 0.367 7.350 0.007 2.705 1.317~5.553 术前病灶定位与手术部位不完全一致 0.839 0.295 8.089 0.004 2.314 1.298~4.126 术后出现水肿 1.135 0.672 2.853 0.091 3.111 0.834~11.613 手术切除程度为部分 1.103 0.591 3.483 0.062 3.013 0.946~9.596 血清维生素B6水平低 0.582 0.218 7.127 0.008 1.790 1.167~2.744 血清单核细胞趋化蛋白-1水平高 0.826 0.372 4.930 0.026 2.284 1.102~4.736
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