Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China.
Neurosurg Rev. 2024 Apr 8;47(1):142. doi: 10.1007/s10143-024-02380-6.
Cervical perivascular sympathectomy (CPVS) can improve communication disorders in children with cerebral palsy (CP); however, there are no research reports on the factors affecting surgical efficacy. This study aimed to establish a nomogram for poor prognosis after CPVS. We collected data from 313 CP patients who underwent CPVS at the Neurosurgery Cerebral Palsy Center of the Second Affiliated Hospital of Xinjiang Medical University from January 2019 to January 2023. Among them, 70% (n = 216) formed the training cohort and 30% (n = 97) the validation cohort. The general data and laboratory examination data of both groups were analyzed. In training cohort, 82 (37.96%) showed improved postoperative communication function. Logistic analysis identified motor function, serum alkaline phosphatase, serum albumin, and prothrombin activity as the prognostic factors. Using these four factors, a prediction model was constructed with an area under the curve (AUC) of 0.807 (95% confidence interval [CI], 0.743-0.870), indicating its ability to predict adverse outcomes after CPVS. The validation cohort results showed an AUC of 0.76 (95% CI, 0.650-0.869). The consistency curve and Hosmer-Lemeshow test (χ = 10.988 and p = 0.202, respectively) demonstrated good consistency between the model-predicted incidence and the actual incidence of poor prognosis. Motor function, serum alkaline phosphatase, serum albumin, and prothrombin activity are independent risk factors associated with the prognosis of communication disorders after CPVS. The combined prediction model has a good clinical prediction effect and has promising potential to be used for early prediction of prognosis of CPVS.
颈血管周围交感神经切除术 (CPVS) 可改善脑瘫 (CP) 患儿的沟通障碍，但目前尚无关于影响手术疗效的因素的研究报告。本研究旨在建立 CPVS 后预后不良的列线图。我们收集了 2019 年 1 月至 2023 年 1 月新疆医科大学第二附属医院神经外科脑瘫中心 313 例 CP 患者 CPVS 术后的数据。其中 70%（n=216）为训练队列，30%（n=97）为验证队列。分析两组的一般资料和实验室检查资料。在训练队列中，82 例（37.96%）术后沟通功能改善。Logistic 分析确定运动功能、血清碱性磷酸酶、血清白蛋白和凝血酶原活性为预后因素。利用这四个因素，构建了一个预测模型，曲线下面积（AUC）为 0.807（95%置信区间 [CI]，0.743-0.870），表明其对 CPVS 后不良预后的预测能力。验证队列的结果显示 AUC 为 0.76（95%CI，0.650-0.869）。一致性曲线和 Hosmer-Lemeshow 检验（χ²=10.988，p=0.202）表明，模型预测的不良预后发生率与实际发生率之间具有良好的一致性。运动功能、血清碱性磷酸酶、血清白蛋白和凝血酶原活性是 CPVS 后沟通障碍预后的独立危险因素。联合预测模型具有良好的临床预测效果，有望用于 CPVS 预后的早期预测。
