Markery stanu zapalnego we krwi obwodowej a odpowiedź na stymulację nerwu błędnego u dzieci z opornymi na leki padaczką: badanie kohortowe retrospektywne
Peripheral blood inflammatory biomarkers and response to vagus nerve stimulation in pediatric drug-resistant epilepsy: A retrospective cohort study
W skrócie
Badacze analizowali 108 dzieci z padaczką oporną na leki, które poddały się zabiegowi stymulacji nerwu błędnego. Stwierdzili, że określone wskaźniki stanu zapalnego zmierzone we krwi przed zabiegiem i 12 miesięcy po nim są powiązane z efektywością leczenia - szczególnie zmniejszenie się wskaźnika neutrofili do limfocytów oraz innych wskaźników stanu zapalnego wiąże się z lepszymi wynikami. Wynika z tego, że proste badania krwi mogą pomóc przewidzieć, którym dzieciom terapia będzie bardziej skuteczna.
Oryginalny abstract (angielski)
UNLABELLED: Vagus Nerve Stimulation (VNS) is an established treatment for drug-resistant epilepsy (DRE) in children, but response rates vary significantly (50%-60%). Given that neuroinflammation is implicated in epilepsy and VNS may modulate systemic inflammation, this study explored associative links between routine blood inflammatory indices and VNS treatment response in pediatric DRE. We retrospectively analyzed 108 pediatric DRE patients who received VNS. Six peripheral inflammatory indices, namely neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and pan-immune-inflammation value (PIV), were calculated at preoperative and post-titration 12 months. We used Multivariable Regression and Latent Change Score Models (LCSM) to assess the impact of baseline status and dynamic postoperative changes. Multivariable analyses revealed associations between inflammatory indices and VNS outcomes. The LCSM demonstrated that the associative roles of these indices were temporally distinct: VNS response showed significant correlations with the magnitude of postoperative change in Lymphocyte count (beta = - 0.73, p < 0.01), NLR (beta = 0.69, p < 0.01), and SIRI (beta = 0.75, p < 0.01), independent of baseline status. Conversely, the associative patterns of PIV and SII were primarily related to their initial baseline levels. CONCLUSION: The efficacy of VNS in pediatric DRE is associated with systemic inflammatory dynamics. Postoperative changes in these inflammatory indices are associated with VNS treatment outcomes and may serve as a potential prognostic indicator for clinical response. WHAT IS KNOWN: • Vagus nerve stimulation (VNS) is an effective therapy for pediatric drug-resistant epilepsy (DRE), yet treatment response varies markedly across individuals. • Neuroinflammation is involved in epileptogenesis, and VNS may exert antiseizure effects via modulating systemic inflammation. • Peripheral inflammatory indices are easily accessible but their associative links with VNS response remain unclear. WHAT IS NEW: • This study first demonstrates that preoperative and postoperative dynamic changes in peripheral inflammatory biomarkers independently associate with VNS efficacy in children. • Latent change score modeling reveals that postoperative reductions in neutrophil-to-lymphocyte ratio (NLR) and systemic inflammatory response index (SIRI) correlate with favorable seizure outcomes, while baseline systemic immune-inflammation index (SII) and pan-immune-inflammation value (PIV) levels help identify favorable candidates. • These low-cost peripheral indices display correlative links with treatment outcomes and may provide preliminary reference information for auxiliary stratification and serial follow-up monitoring.