轻度胃肠炎伴婴幼儿良性惊厥的危险因素分析及预警模型建立
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1.江南大学附属医院 儿科;2.江南大学附属医院 检验科;3.无锡市儿童医院 消化科

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无锡市医院管理中心科研项目(YGZX1222)


Analysis of risk factors and establishment of warning model for BICE
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Scientific research project of Wuxi hospital management center (ygzx1222)

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    摘要:

    目的:探讨影响轻度胃肠炎伴良性婴幼儿惊厥(BICE)惊厥频发(>3次)的危险因素,建立列线图预测模型,并检验其预测能力。 方法:回顾性分析我院2013年10月-2017年12月收治的91例BICE的临床资料,根据惊厥发作次数分为惊厥频发组(>3次)和对照组(≤3次),通过单因素和多因素logistic回归分析确定影响惊厥频发的独立危险因素,并以此构建列线图。采用受试者工作曲线(ROC曲线)及曲线下面积(AUC)、一致性指数(C-index)、校准曲线及决策曲线分析(DCA)对列线图预测能力进行检验。 结果:共纳入符合标准的BICE患儿91例,其中惊厥频发组29例,对照组62例,惊厥频发组患儿的CD4+和CD8+T细胞含量明显低于对照组,轮状病毒阳性率、IL-6、IL-10和TNF-α水平明显高于对照组,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示轮状病毒、CD4+T细胞含量、IL-10和TNF-α水平等是影响BICE患儿惊厥频发的独立危险因素(P<0.05)。将这四种变量纳入并成功构建列线图。AUC(0.848)、C-index(0.875,0.854)、校准曲线及DCA分析表明通过该列线图得出的惊厥频发预测与实际观测有良好的一致性,说明列线图预测效能良好。 结论:BICE患儿惊厥频发是多种因素综合作用的结果,且各种危险因素在惊厥发作次数不同的患儿间存在差异。临床上可依据基于上述危险因素构建的列线图,评估患儿病情,调整治疗方案,提高惊厥管理。

    Abstract:

    Objective: To explore the risk factors that affect the frequent occurrence of convulsions (>3 times) in benign infantile convulsions associated with mild gastroenteritis (BICE), establish a nomogram prediction model, and test its predictive ability. Methods: A retrospective analysis of the clinical data of 91 cases of BICE admitted to the Department of Pediatrics of Affiliated Hospital of Jiangnan University from October 2013 to December 2017 was conducted. According to the number of convulsions, they were divided into frequent convulsions group (>3 times) and control group (≤3 times). Through univariate and multivariate logistic regression analysis to determine the independent risk factors affecting the frequency of convulsions, and construct a nomogram. The receiver operating curve (ROC curve) and area under the curve (AUC), consistency index (C-index), calibration curve and decision curve analysis (DCA) were used to test the predictive ability of the nomogram. Results: A total of 91 cases with BICE who met the criteria were enrolled, including 29 in the frequent convulsions group and 62 in the control group. The content of CD4+ and CD8+ T cells in the frequent convulsions group was significantly lower than that in the control group. The positive rate of rotavirus, IL-6, IL-10 and TNF-α levels were significantly higher than those in the control group, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that rotavirus, CD4+T cell content, IL-10 and TNF-α levels were independent risk factors affecting the frequency of convulsions in cases with BICE (P<0.05). Incorporate these four independent risk factors and successfully construct a nomogram. AUC (0.848), C-index (0.875, 0.854), calibration curve and DCA analysis showed that the prediction of convulsions frequency obtained by the nomogram is in good agreement with the actual observation, indicating that the nomogram has good predictive performance. Conclusion: Frequent convulsions in cases with BICE are the result of multiple factors, and various risk factors are different among children with different seizure times. Clinically, the nomogram constructed based on the above risk factors can be used to evaluate the condition of the children with BICE, adjust the treatment plan, and improve the management of convulsions.

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  • 收稿日期:2021-02-25
  • 最后修改日期:2021-05-28
  • 录用日期:2021-09-01
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