生酮饮食对脑瘫共患癫痫患儿肠道菌群、粗大运动功能及癫痫发作的影响  

Effects of ketogenic diet on gut microbiota,gross motor function,and seizure control in children with cerebral palsy and comorbid epilepsy

作　　者：温壮飞 李发龙 吴良宇 韩露 李小山 蔡青桐 叶小姗 Wen Zhuangfei;Li Falong;Wu Liangyu;Han Lu;Li Xiaoshan;Cai Qingtong;Ye Xiaoshan(Department of Pediatric Rehabilitation,Haikou Hospital of Maternal and Child Health,Haikou 570102,China;Department of Rehabilitation Medicine,Haikou Affiliated Hospital of Central South University Xiangya School of Medicine,Haikou 570208,China)

机构地区：[1]海南省海口市妇幼保健院儿童康复科,海口570102 [2]中南大学湘雅医学院附属海口医院康复医学科,海口570208

出　　处：《保健医学研究与实践》2024年第12期19-26,共8页Health Medicine Research and Practice

基　　金：海南省自然科学基金项目(821MS0848);海南省卫生健康科研项目(21A200079)。

摘　　要：目的探讨生酮饮食(KD)对脑瘫共患癫痫患儿肠道菌群、粗大运动功能及癫痫发作的影响,以期为脑瘫共患癫痫患儿的诊治提供参考。方法选取2022年1月—2024年1月海口市妇幼保健院收治的42例脑瘫共患癫痫患儿,采用随机数字表法分为对照组与观察组,每组21例。对照组患儿接受常规药物治疗与康复治疗,观察组患儿在对照组基础上给予KD治疗,疗程均为24周。比较2组患儿治疗前后的肠道菌群、粗大运动功能测量表(GMFM-88)评分、Gesell发育量表评分、体格发育与抗癫痫药物(AEDs)数量变化情况,并观察癫痫发作控制情况、脑电图(EEG)转归及治疗期间不良反应发生情况。结果治疗前,2组患儿肠道各优势菌群丰度比较,差异无统计学意义(P>0.05);治疗24周后,观察组患儿拟杆菌门、放线菌门、疣微菌门、梭菌纲、丹毒丝菌纲、红蝽菌纲丰度高于对照组,梭杆菌门及β-变形菌纲丰度低于对照组,差异均有统计学意义(P<0.05)。2组患儿GMFM-88评分随治疗时间的增加呈升高趋势,时间及交互效应均有统计学意义(P<0.05);治疗前和治疗12周后,2组患儿GMFM-88评分比较,差异均无统计学意义(P>0.05);治疗24周后,观察组患儿GMFM-88评分高于对照组,差异有统计学意义(P<0.05)。2组患儿Gesell评分随治疗时间的增加呈升高趋势,时间及交互效应均有统计学意义(P<0.05);治疗前和治疗12周后,2组患儿Gesell量表各维度评分比较,差异均无统计学意义(P>0.05);治疗24周后,观察组患儿Gesell量表各维度评分均高于对照组,差异均有统计学意义(P<0.05)。治疗前、12周及24周后,2组患儿生长水平和体型匀称度、营养不良分级比较,差异均无统计学意义(P>0.05)。治疗12周和24周后,观察组患儿癫痫发作控制总有效率均高于对照组,差异均有统计学意义(P<0.05)。2组患儿治疗前和治疗24周后AEDs药物使用数量比较,差异均无统计学意义(P>0.0Objective To investigate the effects of ketogenic diet(KD)on gut microbiota,gross motor function,and seizure control in children with cerebral palsy and comorbid epilepsy,providing a reference for clinical management.Methods A total of 42 children with cerebral palsy and comorbid epilepsy admitted to Haikou Hospital of Maternal and Child Health from January 2022 to January 2024 were assigned to a control group and an observation group(21 cases each)using a random number table.The control group received conventional drug therapy and rehabilitation,while the observation group received additional KD treatment for 24 weeks.Gut microbiota composition,88-item version of the Gross Motor Function Measure(GMFM-88)scores,Gesell Developmental Schedules scores,growth parameters,changes in the number of antiepileptic drugs(AEDs),seizure control outcomes,electroencephalogram(EEG)improvements,and adverse events were compared between the two groups before and after treatment.Results Before treatment,no significant differences were noted in the abundance of dominant gut microbiota between the two groups(P>0.05).After 24 weeks of treatment,the observation group showed higher abundances of Bacteroidetes,Actinobacteria,Verrucomicrobia,Clostridia,Erysipelotrichia,and Coriobacteriia,but lower abundances of Fusobacteria and Betaproteobacteria compared to the control group,with statistically significant differences(P<0.05).The 88-item version of the Gross Motor Function Measure(GMFM-88)scores of both groups increased over time,showing significant time,and interaction effects(P<0.05).Before treatment and at 12 weeks post-treatment,no significant differences were found in GMFM-88 scores between the two groups(P>0.05).At 24 weeks post-treatment,the observation group had significantly higher GMFM-88 scores than the control group(P<0.05).The Gesell Developmental Schedules scores of both groups also increased over time,with significant time,and interaction effects(P<0.05).Before treatment and at 12 weeks post-treatment,no significant differen

关 键 词：生酮饮食 脑瘫 癫痫 儿童 肠道菌群 生长发育 运动功能 

分 类 号：R742.3[医药卫生—神经病学与精神病学] R742.1[医药卫生—临床医学]