儿童创伤后癫痫风险预测模型构建与验证:基于队列研究的Meta分析
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南京医科大学附属儿童医院外科重症监护病房,江苏 南京 210008

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R742.1

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江苏省卫健委医学科研项目(H2023116)


Development and validation of a risk prediction model for post ⁃ traumatic epilepsy in pediatric traumatic brain injury based on meta⁃analysis of cohort studies
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Surgical Intensive Care Unit(SICU),Children’s Hospital of Nanjing Medical University,Nanjing 210008 ,China

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    摘要:

    目的:创伤后癫痫(post-traumatic epilepsy,PTE)是创伤性脑损伤(traumatic brain injury,TBI)的常见并发症,严重影响患者预后,早期预测PTE风险对临床管理至关重要,相比成人,儿童PTE相关研究较少,且缺乏临床公认的高预测效能模型。本研究旨在构建并验证适用于儿童TBI患者的PTE风险预测列线图模型。方法:系统检索中国知网、万方、中国生物医学文献数据库、维普、Pubmed、Embase和Web of Science 数据库中关于儿童PTE危险因素的研究,检索时限为建库至 2024年10月。 采用Stata 15.0软件进行 Meta 分析,根据Meta分析结果提取合并效应量具有显著性的风险因素。回顾性收集2019年1月— 2023年12月南京医科大学附属儿童医院外科重症监护病房(surgical intensive care unit,SICU)收治的262例TBI患儿,按7∶3比例随机划分为训练队列和内部验证队列,基于Meta分析筛选的危险因素,利用R软件构建多因素Logistic回归模型并绘制列线图。采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)评价模型区分度, Hosmer-Lemeshow检验评估校准度,运用决策曲线分析(decision curve analysis,DCA)评估临床实用性。结果:共纳入13项研究,涉及1 371 819例TBI患儿。Meta分析显示,中国TBI儿童中PTE的发病率为19%(95%CI:17%~20%)。结合Meta分析筛选结果和临床经验,最终纳入8个危险因素构建模型:格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分、开放性脑损伤、早期痫性发作、意识丧失以及异常颅脑影像学表现(颅内血肿、脑挫伤、硬膜下出血、蛛网膜下腔出血),预测模型在训练队列和内部验证队列的AUC分别为0.801(95%CI:0.735~0.867,P < 0.05)和0.831(95%CI:0.728~0.934,P < 0.05)。Hosmer-Lemeshow 拟合优度检验示模型拟合良好(训练队列:P=0.079;验证队列:P=0.082)。DCA显示该模型具有较高临床净获益。结论:本研究基于 Meta分析构建的儿童PTE风险预测模型具有良好的区分度、校准度和临床实用性,可作为TBI儿童发生PTE风险评估的有效工具。

    Abstract:

    Objective:Post - traumatic epilepsy(PTE)is a common complication of traumatic brain injury(TBI)that significantly impacts the prognosis. Early prediction of PTE risk is crucial for clinical management. Compared to adults,research on pediatric PTE remains limited,and there is currently no widely accepted high-performance predictive model for children with TBI. This study aimed to develop and validate a nomogram prediction model for PTE risk in pediatric TBI patients. Methods:We systematically searched the China National Knowledge Infrastructure(CNKI),Wanfang,Chinese Biomedical Literature Database(CBM),VIP,PubMed,Embase, and Web of Science for studies on risk factors of pediatric PTE,with a search timeframe from database inception to October 2024. Meta- analysis was performed using Stata 15.0 software to identify risk factors with statistically significant pooled effect sizes. A retrospective cohort of 262 children with TBI admitted to the surgical intensive care unit(SICU)of Nanjing Medical University Affiliated Children’Hospital from January 2019 to December 2023 was included. The children was randomly split into a training cohort(70%)and an internal validation cohort(30%). Based on the risk factors identified in the meta-analysis,a multivariate logistic regression model was constructed using R software,and a nomogram was developed. The model’s discriminative ability was evaluated using the area under the receiver operating characteristic(AUC)curve,calibration was assessed via the Hosmer - Lemeshow test,and clinical utility was examined using decision curve analysis(DCA). Results:A total of 13 observational studies involving 1 371 819 TBI children were included. Meta-analysis revealed that the incidence of PTE in Chinese children with TBI was 0.190(95% CI:0.170-0.200). Based on the meta -analysis findings and clinical expertise,the final prediction model incorporated eight key risk factors:Glasgow Coma Scale (GCS)score,open head injury,early seizure activity,loss of consciousness,and abnormal neuroimaging findings including intracranial hematoma,cerebral contusion,subdural hemorrhage,and subarachnoid hemorrhage. The model demonstrated strong discriminative ability,with AUC of 0.801(95% CI:0.735-0.867,P < 0.05)in the training cohort and 0.831(95% CI:0.728-0.934,P < 0.05)in the validation cohort. The Hosmer-Lemeshow goodness-of-fit test indicated good calibration(training cohort:P=0.079;validation cohort: P=0.082). DCA confirmed substantial clinical net benefit. Conclusion:The PTE risk prediction model developed in this study,based on meta-analysis-derived risk factors,exhibits excellent discrimination,calibration,and clinical utility,serving as an effective tool for PTE risk assessment in children with TBI.

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张慧文,祁红玉,张华,张利娟,王婧,陆巍峰.儿童创伤后癫痫风险预测模型构建与验证:基于队列研究的Meta分析[J].南京医科大学学报(自然科学版),2026,46(1):82-93

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  • 收稿日期:2025-04-01
  • 最后修改日期:2025-07-17
  • 录用日期:2025-08-08
  • 在线发布日期: 2026-01-12
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