COX Regression Analysis on Treatment Efficacy and Prognostic Factors of Methylprednisolone Pulse Therapy in Children with Electrical Status Epilepticus during Sleep

Wang Yun; Lu Guangshuang; Cheng Yun; Lu Xiaoyan; Yang Wu

doi:10.13407/j.cnki.jpp.1672-108X.2023.12.010

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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

更新时间：2023-11-25

- COX Regression Analysis on Treatment Efficacy and Prognostic Factors of Methylprednisolone Pulse Therapy in Children with Electrical Status Epilepticus during Sleep
- Vol. 29, Issue 12, Pages: 44-48(2023)
- 作者机构：
  
  1. 蚌埠医学院,安徽,蚌埠,233030
  2. 安徽医科大学附属六安医院,安徽,六安,237005
- 作者简介：
- 基金信息：
- DOI：10.13407/j.cnki.jpp.1672-108X.2023.12.010
  CLC：
- Published：2023，
  
  Published Online：10 December 2023，
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Wang Yun, Lu Guangshuang, Cheng Yun, et al. COX Regression Analysis on Treatment Efficacy and Prognostic Factors of Methylprednisolone Pulse Therapy in Children with Electrical Status Epilepticus during Sleep. [J]. 29(12):44-48(2023)
DOI：

Wang Yun, Lu Guangshuang, Cheng Yun, et al. COX Regression Analysis on Treatment Efficacy and Prognostic Factors of Methylprednisolone Pulse Therapy in Children with Electrical Status Epilepticus during Sleep. [J]. 29(12):44-48(2023) DOI： 10.13407/j.cnki.jpp.1672-108X.2023.12.010.

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。

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.

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

Keywords

]electrical status epilepticus during sleepmethylprednisolonesurvival analysisprognostic factorschildren

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