胶质瘤术后早发癫痫的危险因素分析以及预测模型构建-现代医学

胶质瘤术后早发癫痫的危险因素分析以及预测模型构建

单位：南京医科大学附属脑科医院神经外科, 江苏南京 210029

分类号：R742.1

出版年·卷·期（页码）：2025·53·第二期（286-293）

摘要：

目的：探讨胶质瘤切除术后早期癫痫发作的风险因素并构建预测模型。方法：回顾性分析2021年1月至2024年4月期间于南京医科大学附属脑科医院行开颅胶质瘤切除术的495例患者的临床资料，根据术后早期是否出现癫痫发作分为癫痫组(n=32)和非癫痫组(n=463)。比较两组患者临床风险因素，确定胶质瘤切除术后早期癫痫发作的风险因素，根据结果构建预测模型，绘制ROC曲线分析预测模型对癫痫发作的预测价值。结果：本研究纳入495例接受开颅胶质瘤切除术的原发性胶质瘤患者，术后早期癫痫发作率为6.46%(32/495)。逐步Logistic回归分析显示，术前癫痫发作(OR=3.980，95%CI：2.261～6.452)、肿瘤位于额叶(OR=1.643，95%CI：1.447～5.961)、肿瘤直径≥5 cm (OR=2.792，95%CI：1.244～5.046)、累及皮层(OR=2.059，95%CI：1.428～4.742)、病理分级为Ⅱ级(OR=1.318，95%CI：1.182～3.136)、未行AEDs预防性应用(OR=3.078，95%CI：1.627～7.741)是胶质瘤切除术后早期癫痫发作的风险因素。根据上述危险因素构建风险预测模型，该模型预测胶质瘤术后早期癫痫发作的ROC曲线下面积为0.814(95%CI：0.747～0.881)，灵敏度和特异度分别为0.79和0.80。结论：在原发性胶质瘤术后患者中，术前癫痫发作史、肿瘤位于额叶、肿瘤直径≥5 cm、肿瘤累及皮层、病理分级为Ⅱ级、未行AEDs预防用药是导致术后早期癫痫发作的危险因素，据此构建的风险预测模型预测性能较好，便于护理人员对患者的癫痫风险进行评估，及早进行护理干预。

Objective: To analyze the risk factors and construct a prediction model for early postoperative epileptic seizures after glioma resection. Methods: A retrospective analysis was conducted of the clinical data of 495 patients who underwent craniotomy for glioma resection in Brain Hospital Affiliated to Nanjing Medical University from January 2021 to April 2024. Based on the occurrence of early-onset seizures after surgery, the patients were divided into a seizure group(n=32) and a non-seizure group(n=463). The clinical risk factors of the two groups were compared to identify the risk factors for early-onset seizures following glioma resection. A predictive model was then constructed based on these results, and the ROC curve was plotted to analyze the predictive value of the model for seizure occurrence. Results: Our study included 495 patients with primary glioma who underwent craniotomy for glioma resection. The incidence of early-onset seizures after surgery was 6.46%(32/495). Stepwise logistic regression analysis revealed that preoperative seizures(OR=3.980, 95%CI:2.261-6.452), tumor located in the frontal lobe(OR=1.643, 95%CI:1.447-5.961), tumor diameter ≥ 5 cm(OR=2.792, 95%CI:1.244-5.046), cortical tumor infiltration(OR=2.059, 95%CI:1.428-4.742), pathological grade Ⅱ(OR=1.318, 95%CI:1.182-3.136), and lack of prophylactic AEDs use(OR=3.078, 95%CI:1.627-7.741) were risk factors for early-onset seizures after glioma resection. A risk prediction model was constructed based on these risk factors, and the area under the ROC curve for predicting early-onset seizures after glioma surgery was 0.814(95%CI:0.747-0.881), with a sensitivity of 0.79 and a specificity of 0.80. Conclusion: In patients who have undergone surgery for primary glioma, preoperative history of seizures, tumor location in the frontal lobe, tumor diameter ≥ 5 cm, cortical involvement of the tumor, pathological grade Ⅱ, and lack of prophylactic AEDs use are risk factors leading to early-onset of postoperative seizures. The constructed risk prediction model has good predictive performance, facilitating nursing staff to assess the patient's seizure risk and intervene early with appropriate care.

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