癫痫睡眠期发作间期脑电图放电指数联合超氧化物歧化酶对认知功能损害的预测价值

Predictive value of interictal epileptiform discharge index during sleep combined with superoxide dismutase for cognitive impairment in epilepsy

摘要:

目的 探讨癫痫睡眠期发作间期脑电图放电指数联合超氧化物歧化酶（SOD）对认知功能损害的预测价值。方法 选取2021年1月—2024年1月新疆生产建设兵团医院收治的100例癫痫患者，根据蒙特利尔认知评估量表（MoCA）评分分为认知正常组77例和认知障碍组23例。比较两组的一般资料、睡眠期发作间期脑电图放电指数及SOD水平；采用多因素一般Logistic回归分析癫痫患者认知功能损害的影响因素并构建列线图；采用Spearman法分析相关指标的相关性。构建受试者工作特征（ROC）曲线分析认知功能损害的预测效能。结果 认知障碍组的病程、首发至就诊时间、发作频率、睡眠期发作间期脑电图放电指数及MDA均高于认知正常组（P <0.05），SOD低于认知正常组（P <0.05）。多因素一般Logistic回归分析结果显示，病程长［O^R =33.937（95% CI：4.633，248.584）］、首发至就诊时间长［O^R =11.126（95% CI：1.756，70.514）］、发作频率高［O^R =27.343（95% CI：1.434，521.22）］、睡眠期发作间期脑电图放电指数高（［O^R =82.006（95% CI：5.147，1 306.611）］、MDA水平高［O^R =5.456（95% CI：1.380，21.567）］及SOD水平高［O^R =0.768（95% CI：0.650，0.908）］是癫痫患者认知功能损害的影响因素（P <0.05）。患者的病程、首发至就诊时间、发作频率、睡眠期发作间期脑电图放电指数及MDA与MoCA评分呈负相关（r_s =-0.741、-0.235、-0.259、-0.279和-0.500，P =0.000、0.019、0.009、0.005和0.000），SOD与MoCA评分呈正相关（r_s =0.229，P =0.022）。ROC曲线结果表明，睡眠期发作间期脑电图放电指数、SOD联合预测的曲线下面积为0.819，敏感性为96.4%（95% CI：0.888，1.000）、特异性为61.8%（95% CI：0.509，0.726），分别高于睡眠期发作间期脑电图放电指数［曲线下面积为0.691，敏感性为95.7%（95% CI：0.760，0.998）、特异性为35.1%（95% CI：0.244，0.457）］和SOD［曲线下面积为0.764，敏感性为95.7%（95% CI：0.760，0.998）、特异性为50.6%（95% CI：0.395，0.618）］单独预测。结论 癫痫睡眠期发作间期脑电图放电指数联合SOD对认知功能损害有着良好的预测价值。

Abstract:

Objective To explore the predictive value of the interictal epileptiform discharge index during sleep combined with superoxide dismutase (SOD) for cognitive impairment in epilepsy.Methods A total of 100 epilepsy patients admitted to the Xinjiang Production and Construction Corps Hospital from January 2021 to January 2024 were selected and divided into the normal cognition group (n = 77) and the cognitive impairment group (n = 23) based on the Montreal Cognitive Assessment (MoCA) scores. General data, interictal epileptiform discharge index during sleep, and superoxide dismutase levels were compared between the two groups. Multivariable Logistic regression analysis was used to identify the factors affecting cognitive impairment in epilepsy patients and the nomogram was established. The Spearman correlation analysis was performed to assess the correlations between indicators. The receiver operating characteristic (ROC) curve was constructed to analyze the predictive efficacy for cognitive impairment.Results The cognitive impairment group exhibited longer duration of illness and time from onset to medical consultation, and higher frequencies of seizures, interictal electroencephalographic discharge index during sleep, and MDA levels (P < 0.05), but lower SOD levels compared to the normal cognition group (P < 0.05). Multivariable Logistic regression analysis indicated that longer duration of illness [O^R = 33.937 (95% CI: 4.633, 248.584) ], longer time from onset to medical consultation [O^R = 11.126 (95% CI: 1.756, 70.514) ], higher frequencies of seizures [O^R = 27.343 (95% CI: 1.434, 521.22) ], higher interictal electroencephalographic discharge index during sleep [O^R = 82.006 (95% CI: 5.147, 1306.611) ], higher MDA levels [O^R = 5.456 (95% CI: 1.380, 21.567) ], and lower SOD levels [O^R = 0.768 (95% CI: 0.650, 0.908) ] were factors affecting the cognitive function in epilepsy patients (P < 0.05). SOD levels were positively correlated with MoCA scores (r_s = 0.229, P = 0.022), while duration of illness, time from onset to consultation, the frequency of seizures, the interictal electroencephalographic discharge index during sleep, and MDA levels were negatively correlated with MoCA scores (r_s = -0.741, -0.235, -0.259, -0.279, and -0.500, P = 0.000, 0.019, 0.009, 0.005, and 0.000, respectively). The ROC curve analysis demonstrated that the area under the curve (AUC) of the combination of interictal epileptiform discharge index during sleep and SOD was 0.819, with a sensitivity of 96.4% (95% CI: 0.888, 1.000) and a specificity of 61.8% (95% CI: 0.509, 0.726), which was superior to the predictive performance using the interictal electroencephalographic discharge index during sleep [AUC = 0.691, sensitivity 95.7% (95% CI: 0.760, 0.998), specificity 35.1% (95% CI: 0.244, 0.457) ] or SOD alone [AUC = 0.764, sensitivity 95.7% (95% CI: 0.760, 0.998), specificity 50.6% (95% CI: 0.395, 0.618) ].Conclusions The interictal epileptiform discharge index during sleep combined with SOD has a good predictive value for cognitive impairment in epilepsy.