泼尼松龙与促肾上腺皮质激素治疗婴儿痉挛的临床对比研究  

Clinical comparison between prednisolone and adrenocorticotropic hormone in the treatment of infantile spasms

作　　者：蒋志平[1] 彭骞[1] 罗丹[1] 袁远宏[2] JIANG Zhi-ping;PENG Qian;LUO Dan;YUAN Yuan-hong(Department of Pharmacy,Hunan Children′s Hospital,Changsha 410007,China;the First ICU,Hunan Children′s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院药学部,湖南长沙410007 [2]湖南省儿童医院重症监护一科,湖南长沙410007

出　　处：《实用药物与临床》2019年第6期634-637,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的比较泼尼松龙与促肾上腺皮质激素对婴儿痉挛症的临床疗效。方法按照随机数字表法将我院2014年6月至2015年5月收治的91例确诊为婴儿痉挛症的患儿分为泼尼松龙治疗组(泼尼松龙组,43例)和促肾上腺皮质激素(ACTH)治疗组(ACTH组,48例)。泼尼松龙组患儿给予静滴泼尼松龙磷酸钠酯2.0 mg/(kg·次),q12 h,加入5%葡萄糖注射液500 ml中滴注。ACTH组患儿静滴ACTH 20 IU/d。比较两组治疗1、2、4周后的总体有效率、患儿智商(DQ)和智力指数(MI)评分、不良反应发生率以及3年内病情复发率。结果 ACTH组治疗1、2、4周后的总体有效率分别为83.33%、93.75%、97.92%,高于泼尼松龙组(74.22%、83.72%、90.70%),差异有统计学意义(P<0.05)。ACTH组治疗4周后不良反应发生率以及3年内复发率低于泼尼松龙组,而患儿的智商和智力指数评分高于泼尼松龙组,差异均有统计学意义(P<0.05)。结论 ACTH对婴儿痉挛症的临床疗效优于泼尼松龙,且不良反应发生率和复发率较泼尼松龙显著降低,提示ACTH能明显改善婴儿痉挛症的症状,提高患儿生活质量,全身不良反应较轻,且疗效与病程呈正相关。Objective To compare the clinical efficacy of prednisolone with that of adrenocorticotropic hormone in the treatment of infantile spasms.Methods According to the random number table,a total of 91 cases of infantile spasms diagnosed in our hospital from June 2014 to May 2015 were divided into prednisolone treatment group(prednisolone group,n=43) and adrenocorticotropic hormone(ACTH) treatment group(ACTH group,n=48).Patients in prednisolone group were given prednisolone sodium phosphate 2.0 mg/kg every time(q12 h) infused with 500 ml of 5% glucose injection.ACTH group was given ACTH 20 IU/d intravenously.The overall effective rate,intelligence quotient(DQ) and intelligence index(MI) score at 1,2 and 4 weeks after treatment,incidence of adverse reactions and recurrence rate of the disease within 3 years of the two groups were compared.Results The overall effective rate of ACTH group at 1,2 and 4 weeks after treatment were 83.33%,93.75% and 97.92%,respectively,which were higher than those of prednisolone group(74.22%,83.72% and 90.70%),there being significant differences(P<0.05).The incidence of adverse reactions after 4 weeks of treatment and relapse rate within 3 years in ACTH group were lower than those in prednisolone group(P<0.05),while the children′s DQ and MI scores were higher than those of prednisolone group(P<0.05).Conclusion ACTH has better clinical efficacy on infantile spasms than prednisolone with lower incidence of adverse reactions and recurrence rate,suggesting that ACTH can significantly improve the symptom of infantile spasms,improve the quality of life of children,and have less systemic side effects.The efficacy is positively correlated with the course of the disease.

关 键 词：泼尼松龙 促肾上腺皮质激素 婴儿痉挛症 

分 类 号：R742.1[医药卫生—神经病学与精神病学]