| 陈静，李春.拉莫三嗪与丙戊酸钠联合方案治疗脑卒中后癫痫患者无效的影响因素及预测[J].神经损伤功能重建,2025,(3):139-143 |
| 拉莫三嗪与丙戊酸钠联合方案治疗脑卒中后癫痫患者无效的影响因素及预测 |
| Factors Influencing the Inefficacy of the Combination Therapy of Lamotrigine and SodiumValproate in Treating Patients with Post-stroke Epilepsy and its Prediction |
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| DOI： |
| 中文关键词: 脑卒中后癫痫 拉莫三嗪 丙戊酸钠 临床疗效 倾向性评分匹配法 影响因素 |
| 英文关键词: post-stroke epilepsy Lamotrigine Sodium valproate clinical curative effect propensity score matching method influencing factor |
| 基金项目: |
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| 中文摘要: |
| 目的：分析拉莫三嗪与丙戊酸钠联合方案治疗脑卒中后癫痫患者无效的相关因素。方法：收集2020年3
月至2023年4月于武汉大学中南医院治疗的269例脑卒中后癫痫患者临床资料，根据拉莫三嗪联合丙戊酸钠
疗效分为有效组（n=215）和无效组（n=54），随机选取其中219例作为训练集，50例作为验证集。采用倾向性评
分匹配对有效组和无效组患者进行匹配，再对均衡协变量的数据集采用Logistic回归模型分析影响拉莫三
嗪联合丙戊酸钠疗效的相关因素，由此建立预测模型，再用受试者工作特征（Receiver Operating Characteristic，ROC）曲线评估该模型的预测性能。结果：219例卒中后癫痫患者经1∶1倾向性评分匹配后，共42对患者
匹配成功，年龄、性别、基础疾病、吸烟史和饮酒史资料基本均衡。有效组NIHSS评分＞14分、每月发作次数
≥4次、同型半胱氨酸及尿酸水平低于无效组，差异有统计学意义（P＜0.05）。Logistic回归分析结果显示，
NIHSS 评分＞14 分、每月发作次数≥4 次、高同型半胱氨酸水平是患者治疗无效的独立影响因素（P＜
0.05）。构建预测模型，P=e
X
（/ 1+e
X
），X=－8.423+0.532×NIHSS评分情况+0.575×每月发作次数情况+0.436×
同型半胱氨酸，Hsomer-Lemeshow拟合优度检验显示模型预测值与实际观测值间，差异无统计学意义（P＞
0.05）；对预测模型进行内部验证，其AUC为0.818，敏感度为78.57%，特异度为73.81%（P＜0.05）；以验证集
患者数据对模型进行外部验证，其AUC为0.815，敏感度为62.50%，特异度为88.10%。结论：NIHSS评分＞
14分、每月发作次数≥4次、高同型半胱氨酸水平是拉莫三嗪联合丙戊酸钠治疗无效的独立影响因素，该预
测模型对疗效的预测能力良好。 |
| 英文摘要: |
| To analyze the influencing factors of ineffective treatment with lamotrigine combined
with sodium valproate in patients with post-stroke epilepsy. Methods: The clinical data were collected from 269
patients with post-stroke epilepsy in the Zhongnan Hospital of Wuhan University between March 2020 and April
2023. According to curative effect of lamotrigine combined with sodium valproate, patients were divided into
effective group (n=215) and ineffective group (n=54). Among them, 219 cases were randomly selected as the
training set and the other 50 cases were selected as the verification set. The patients in effective group and
ineffective group were matched by propensity score matching method. In data set of balanced covariates,
influencing factors of the curative effect were analyzed by Logistic regression model. The prediction model for
the curative effect was constructed, and its predictive efficiency was evaluated by receiver operating characteristic
(ROC) curves. Results: In the 219 patients with post-stroke epilepsy after 1 ∶ 1 propensity score matching
method, there were 42 pairs of patients with successful matching, and the data such as age, gender, underlying
diseases, smoking history and drinking history were basically balanced. The proportions of NIHSS score >14
points and monthly onset frequency ≥4 times, levels of homocysteine and uric acid in effective group were lower
than those in ineffective group (P<0.05). The results of Logistic regression analysis showed that NIHSS score >14
points, monthly onset frequency ≥4 times and high level of homocysteine were independent influencing factors
of ineffective treatment (P<0.05). The prediction model was as follow: P=e
X
/(1+e
X
), X=－8.423+0.532×NIHSS
score +0.575× monthly onset frequency +0.436× homocysteine. Hsomer-Lemeshow goodness-fit test showed that
there was no significant difference between predicted value of the model and the actual observed value (P>0.05).
Internal verification of the prediction model showed that AUC, sensitivity and specificity were 0.818, 78.57% and
73.81%, respectively (P<0.05). External verification of the prediction model with validation set data showed that
AUC, sensitivity and specificity were 0.815, 62.50% and 88.10%, respectively. Conclusion: NIHSS score >14
points, monthly onset frequency ≥4 times and high level of homocysteine are independent influencing factors of
ineffective treatment with lamotrigine combined with sodium valproate. The prediction model has good
predictive efficiency for the curative effect. |
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