添加生酮饮食治疗难治性癫痫的长期保留率和不良反应  

Long-term retention rate and side effects of ketogenic diet in Chinese patients with refraetory epilepsy

作　　者：邓宇虹[1,2] 周锦华 黎冰梅[1,2] 刘晓蓉[1,2] 廖卫平[1,2] 

机构地区：[1]广州医学院第二附属医院神经内科 [2]广州医学院神经科学研究所,广东广州510260 [3]广东三九脑科医院神经内科,广东广州510510

出　　处：《肠外与肠内营养》2012年第6期355-358,共4页Parenteral & Enteral Nutrition

基　　金：广州医学院留学归国人员项目资助(0707083);广东省医学科学技术研究基金项目资助(A2011259)

摘　　要：目的:评价添加生酮饮食(KD)治疗难治性癫痫的长期保留率和不良反应。方法:将28例难治性癫痫病人在1年半内陆续入组。病人住院期间以脂肪/(蛋白质+糖类)重量比=4∶1饮食开始,出院继续4∶1或适当减低比例。随访3、6和12个月的保留率,统计疗效和不良反应的发生率。结果:3、6和12个月的保留率分别为68%(19/28)、43%(10/23)和28%(5/18)。3个月时68%(19/28)病人减少>50%的发作,43%(12/28)病人减少>90%的发作,无发作率为11%(3/28)。启动期主要不良反应为胃肠道不适、酮症酸中毒、低血糖;维持期主要不良反应为便秘、高脂血症和低蛋白血症,仅有1例因不良反应而退出。结论:添加生酮饮食治疗难治性癫痫病人疗效较高,但保留率不高。不良反应不是治疗失败的主要原因,如何根据中国人的生活习惯来提高操作性是努力的方向。Objective： To evaluate the effect and long-term retention of ketogenic diet（KD） in add-on therapy for refractory epilepsy patients with Chinese eating habits.Methods： 28 Chinese patients with refractory epilepsy were recruited in one and half a year.In the first three months,there were no changes of the anti-epilepsy drug.All patients were hospitalized and started with fat/（protein＋carbohydrates） = 4∶ 1 diet,then maintained the 4∶ 1 diet after discharged.According to the recruiting day,the follow-up period persisted from 3 months to 12 months.The retention rate,the efficacy and the incidence of side effects were observed.Results： On the third month,68% of patients reduced 50% seizures,43%（12/28） of patients reduced 90% seizures,11% were seizure-free.The retention rate was 68%（19/28） at the third month,while it was 43%（10/23） at the sixth month and 28%（5/18） at one year.The major side effects in the first two weeks were gastrointestinal reactions,ketoacidosis and low glucose.The major side effects in the persistence period were constipation,hyperlipidemia,and hypoalbuminemia.Only one patient withdrew the diet due to side effects.Conclusion： KD in Chinese refractory epilepsy patients is highly effective,but the long-term retention rate is low,probably related to the Chinese eating habits.Better implementation is needed to be studied.

关 键 词：生酮饮食 难治性癫痫 保留率 不良反应 

分 类 号：R742.1[医药卫生—神经病学与精神病学]