两种生酮饮食方案治疗儿童难治性癫痫的随机对照研究  

Randomized control study on two different protocols of ketogenic diet for refractory epilepsy in children

作　　者：胡雁[1] 路新国[1] 文家伦[1] 王春[1] 陈黎[1] 陈彦[1] 廖建湘[1] 

机构地区：[1]深圳市儿童医院神经内科暨癫痫中心,518026

出　　处：《中国小儿急救医学》2012年第5期473-476,共4页Chinese Pediatric Emergency Medicine

基　　金：基金项目：深圳市科技计划项目（200903105）

摘　　要：目的评估按需和按时服用生酮饮食（ketogenicdiet，KD）两种方案的疗效和安全性。方法采用随机数字表法将60例难治性癫痫患儿随机分成按需服用KD组和按时服用KD组，每组30例。全量服用KD后连续72h每6小时监测血酮、血糖和尿酮，比较两组患JLN症状态的稳定性。记录发作频率并确定起效时间，分别在治疗后4周、12周、24周、48周评估两组患儿的疗效及安全性。结果治疗4周后，按需服用KD组与按时服用KD组发作完全缓解率分别为33．3％（10／30）与30．0％（9／30），两组疗效相当（P〉0．05）。按需服用KD组治疗有效病例平均起效时间为（6．18±2．42）d，而按时服用KD组有效病例平均起效时间为（8．63±2．63）d，两组比较差异有统计学意义（P〈0．05）。治疗后12周、24周和48周，按需服用KD组发作完全缓解率分别为30．0％（9／30）、34．8％（8／23）和36．8％（7／19）；按时服用KD组发作完全缓解率分别为33．3％（10／30）、30．4％（7／23）和44．4％（8／18），两组比较差异无统计学意义（P〉0．05）。1年后，按需服用KD组和按时服用KD组治疗保留率分别为63．3％（19／30）与60．0％（18／30），两组比较差异无统计学意义（P〉0．05）。治疗过程中，按需服用KD组与按时服用KD组的不良反应主要为可治疗的胃肠道反应和代谢紊乱。结论按需服用KD和按时服用KD两种治疗方案均基本安全有效，按需服用方案更易达到酮症状态，起效更迅速，较易被患儿接受。因此在临床实施过程中可根据患儿的饮食习惯，灵活安排进食时间以提高治疗的依从性。Objective To assess the efficacy and safety of two different protocols of ketogenic diet （KD） -eating on demand or eating at regular intervals for refractory epilepsy in children. Methods Sixty children with refractory epilepsy were randomly divided into eating on demand group （ n = 30） and eating at regular intervals group （n = 30） by random number table method. After taking the whole amount of KD, the capillary blood ketone and glucose level and urine ketone were monitored every 6 hours in 72 continuous hours. Seizure frequency and onset time were recorded. Antiepileptic efficacy and diet tolerability of the two groups were evaluated on 4 weeks, 12 weeks,24 weeks and 48 weeks after initiating the diet. Adverse effects were monitored. Results After treatment of 4 weeks,the complete seizure remission rates of eating on demand group and eating at regular intervals group were 33.3% （10/30） and 30. 0% （9/30） respectively ,which suggested a com- parable efficacy for two groups （P 〉0. 05）. The day when KD started to work was averaged （6. 18 ±2. 42） d and （ 8. 63 ± 2. 63 ） d respectively. The group of eating on demand showed a faster onset of action （ P 〈 0. 05 ）. After treatment of 12 weeks, 24 weeks and 48 weeks, complete seizure remission rates of eating on demand group were 30. 0% （9/30） ,34. 8 % （8/23） and 36. 8 % （7/19 ） respectively;the eating at regular intervals group were 33.3% （ 10/30）, 30.4% （ 7/23 ） and 44.4% （ 8/18 ） respectively. The two groups had no significant difference （P 〉 0. 05 ）. One year later, the treatment retention rates of the two groups were 63.3 % （19/30） and 60. 0% （18/30） respectively. There was no significant difference （P 〉0. 05）. The adverse effects mainly inclu- ding transient gastrointestinal symptoms and metabolic disturbances were mostly tolerable and curable. Conclusion The two different protocols of KD-eating on demand and eating at regular intervals are both effective and well-tolerated for re

关 键 词：生酮饮食 难治性癫痫 儿童 

分 类 号：R742.1[医药卫生—神经病学与精神病学]