生酮饮食治疗婴儿痉挛25例临床分析  

Clinical analysis of ketogenic diet for 25 children with infantile spasms

作　　者：胡春辉[1] 王华[1] 

机构地区：[1]中国医科大学附属盛京医院小儿神经内科,沈阳110004

出　　处：《中华实用儿科临床杂志》2015年第7期532-534,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 评估生酮饮食（KD）疗法在婴儿痉挛中的疗效、依从性及安全性,从而为婴儿痉挛的治疗提供有效依据.方法 对25例临床诊断为婴儿痉挛的患儿进行KD治疗.患儿均采用气相色谱-质谱法、高效液相色谱-串联质谱法除外代谢性疾病,行血常规、尿常规、粪常规、血脂、肝功能、心电图、脑电图、泌尿系统彩超等相关检查.患儿入院后均用过抗癫癎药后采用KD疗法,所有患儿不经过禁食直接启动KD.随访其疗效、依从性及不良反应.结果 KD维持治疗1个月、3个月、6个月者分别为25例（100％,25/25例）,22例（88％,22/25例）,10例（40％,10/25例）.25例患儿中7例（28％,7/25例）癫癎发作完全控制,均在1个月内控制.达Ⅱ级、Ⅲ级疗效者分别为32％（8/25例）、12％（3/25例）.KD治疗期间13例患儿出现轻重不一的消化系统症状,10例患儿出现无症状性低血糖症状,9例患儿出现睡眠增多症状,但经过对症治疗后,绝大多数患儿不良反应均可消退.仅4例患儿因不良反应大终止治疗.结论 KD对治疗婴儿痉挛效果肯定;KD虽有一些不良反应,但可以耐受;KD＋抗癫癎药物联合治疗1-6个月尚未见严重器官功能障碍.Objective To assess the efficacy,compliance and safety of ketogenic diet （KD） for children with infantile spasms,thus to provide an effective basis for the treatment of infantile spasms.Methods Twenty-five patients with infantile spasms were treated with KD.The gas chromatography-mass spectrometry and high performance liquid chromatography-mass spectrometry （HPLC-MS/MS） were used,except for metabolic diseases,to detect the blood routine,urine,stool,blood Iipids,liver function,as well as electrocardiogram （ECG）,electroencephalograph （EEG）,ultrasound of the urinary system and other related checks of all patients.The KD antiepileptic drug therapy was given after all children were admitted to hospital,and KD started directly in all patients without fasting.The efficacy compliance and safety were followed up in this study.Results KD maintenance therapy for 1 month,3 mouths,6 months were given to 25 cases （100%,25/25 cases）,to 22 cases （88%,22/25 cases）,and to 10 cases （40%,10/25 cases）,respectively.Among them 7 patients （28%,7/25 cases） were in complete control of seizures within 1 month.Up to Class Ⅱ,Ⅲ efficacy level accounted for 32% （8/25 cases）,12% （3/25 cases）,respectively.Thirteen cases of children had varying digestive symptoms,10 cases of them developed asymptomatic hypoglycemia,and 9 cases of children had sleep trouble during KD treatment,but after symptomatic treatment,children＇s adverse reactions almost subsided.Only 4 cases of children discontinued treatment due to adverse reactions.All children＆#39;s seizures were fully controlled.Conclusions The effect of KD is sure in the treatment of infantile spasms.Although KD has some adverse reactions,but it can be tolerated;serious body organ dysfunction treated by KD ＋ antiepileptic drugs combination therapy for 1 to 6 months is not found yet,so the therapy is worthy of promotion clinically.

关 键 词：生酮饮食 婴儿痉挛 疗效 

分 类 号：R742.1[医药卫生—神经病学与精神病学]