促皮质素与生酮饮食治疗新发婴儿痉挛症的随机对照研究  

Adrenocorticotrophic Hormone versus Ketogenic Diet Therapy for Infantile Spasms:A Randomized Controlled Trial

作　　者：操德智[1] 胡雁[1] 朱艳伟[1] 赵霞[1] 李冰[1] 陈黎[1] 黄铁栓[1] 陈彦[1] 廖建湘[1] 

机构地区：[1]重庆医科大学附属深圳市儿童医院神经内科,广东深圳518026

出　　处：《实用儿科临床杂志》2011年第18期1442-1445,共4页Journal of Applied Clinical Pediatrics

基　　金：2009年深圳市科技计划项目资助(200903101)

摘　　要：目的通过促皮质素(ACTH)与生酮饮食(KD)治疗新发婴儿痉挛症(IS)的随机对照研究,比较二者的疗效、安全性、耐受性,证实KD能否作为IS的首选治疗方法。方法将不同时间收治的30例IS新发病例随机分为2组,每组15例。分别给予KD及ACTH治疗,于治疗2周及1、3、6、12个月观察和对比二者的疗效、脑电图改善情况、不良反应及治疗保留率情况。结果治疗2周,ACTH组与KD组无发作比例分别为71.4%(10/14例)与33.3%(5/15例),ACTH组优于KD组(P=0.039),ACTH治疗有效病例起效时间为(6.00±4.10)d,而KD治疗有效病例起效时间为(9.31±3.59)d,ACTH组起效快于KD组(P<0.05),但治疗3、6、12个月,ACTH组无发作比例分别为50.0%、35.7%、28.6%;KD组无发作比例分别为85.7%、81.8%、75.0%。KD组均优于ACTH组(P=0.045,0.025,0.043),同时脑电图的高峰节律紊乱背景的改善情况与发作控制情况基本平行。1 a后,ACTH组与KD组治疗保留率分别为26.7%(4/15例)及40%(6/15例),二者差异无统计学意义(P=0.227)。观察期间,ACTH组与KD组分别出现19例次与16例次的不良反应,但经对症处理后均能很快好转。结论 ACTH治疗IS起效较KD快,近期疗效优于KD治疗,但其停药后复发率逐渐增高,远期疗效不及KD治疗,提示KD可考虑作为IS的首选治疗方案。Objective To confirm whether ketogenic diet（KD） can be the first-line therapy for infantile spasms by comparing the efficacy,safety and tolerability of adrenocorticotrophic hormone（ACTH） therapy and KD therapy. Methods Thirty cases of new-onset infantile spasms were randomly divided into 2 groups,and the ACTH and the KD therapies were administered in 2 groups separately,to observe and compare the clinical efficacy,improvement of electroence phalogram（EEG）,side effects and remaining ratio after 2 weeks′,1,3,6,12 months′ treatment. Results After 2 weeks,ACTH resulted in spasm-freedom in 10 out of 14 cases（71.4%） infants,compared to 5 of 15 cases（33.3%） treated with KD（P=0.039）.The patients′ reaction to ACTH was more rapid [（6.00±4.10） d] compared to KD [（9.31±3.59） d]（P0.05）.After 3,6,12 months,the ratio of cessation of infantile spasms treated with KD was 85.7%,81.8%,75% respectively,compared to 50%,35.7%,28.6% treated with ACTH（P=0.045,0.025,0.043）.The improvement of EEG was associated closely with the clinical efficacy.After 1 year,the remaining ratios of treatment in ACTH group was 26.7%（4/15 cases）,compared to 40%（6/15 cases） in KD group（P=0.227）,the factors for cessation of treatment were respectively relapse and tolerability.Side effects rate in ACTH group was 19 person-times,compared to 16 person-times on KD group.All side effects were turned better by symptomatic therapies. Conclusions ACTH may cease spasms and normalize EEG more rapidly than KD for infantile spasms,but the relapse rate increases gradually after the treatment,the long-term efficacy is worse than KD.It suggests KD can be the first-line therapy for infantile spasms.

关 键 词：促皮质素 生酮饮食 婴儿痉挛症 疗效 不良反应 

分 类 号：R742.1[医药卫生—神经病学与精神病学]