儿童睡眠中癫痫性电持续状态治疗的Meta分析

发布时间：2018-05-24 12:54

本文选题：睡眠中癫痫性电持续状态 + 睡眠　；参考：《山东大学》2017年硕士论文

【摘要】：背景:非快速动眼睡眠期持续棘慢波发放占整个睡眠期50%以上即可诊断睡眠期癫痫性电持续状态(ESES)。Landau-Kleffner综合征、不典型儿童良性癫痫伴中央颞区棘波变异型、癫痫伴慢波睡眠期持续棘慢波等癫痫性脑病均可出现,这种特殊的脑电活动可严重影响语言、认知、发育等功能。在ESES临床治疗中,会使用抗癫痫药物(AEDs,antiepileptic drug)、促肾上腺皮质激素、静脉注射丙种球蛋白(IVIG,intravenous immune globulin)、免疫治疗、生酮饮食(KD,ketogenic diet)等治疗方式,但疗效均不显著。作为多个同类研究和大量文献综合分析的重要方法,Meta分析是解决同一医学问题多种研究报告的循证医学手段,可以通过对研究结果进行系统的、定量的、综合的统计分析,这样不但能协助研究疾病的药物治疗,还对疾病的预防与筛查、流行病学研究等有重要指导意义。如果在临床中能够正确以及合理的应用Meta分析,可以为临床工作和研究提供极大的帮助。目的:本研究旨在通过Meta分析,评估ESES各种治疗方案的有效性,确定不同治疗方案对ESES的治疗价值,为临床用药提供理论依据。方法:通过Ebsco数据库,Elsevier sciencedirect数据库,Medline数据库,Pubmeb数据库,Web of science数据库,相关期刊论文(CNKI)、维普数据库(VIP)、中国生物医学文献数据库(CBM)来进行文献的检索工作。合并各纳入研究治疗的有效率来实现对ESES疾病治疗方法有效性的评定。文章中各研究间的异质性分析主要是通过Q检验以及I2统计量来表示,如果各个研究间的异质性比较大,则要采用随机效应模型(random effects model,REM)合并其有效率,反之则采用固定效应模型(fixed effects model,FEM)来合并统计量。发表偏倚通过漏斗图检测,数据分析应用Stata 13.0来完成。结论:Meta分析结果显示生酮饮食的临床有效性最低,手术治疗和抗癫痫药物治疗的临床有效性相比,手术治疗的有效性相对较高。
[Abstract]:Background: the non rapid eye sleep duration spinous wave is more than 50% of the whole sleep period, which can diagnose the epileptic electric persistent state (ESES).Landau-Kleffner syndrome in the sleep period, the atypical children with benign epilepsy with the central temporal spinous wave variant, and the epilepsy associated with the slow wave of the slow wave and other epileptic encephalopathy. EEG activity can seriously affect language, cognition, development and other functions. In ESES clinical treatment, antiepileptic drugs (AEDs, antiepileptic drug), adrenocorticotropin, intravenous immunoglobulin (IVIG, intravenous immune globulin), immunotherapy, and ketogenic diet (KD, ketogenic diet) are used, but the curative effect is not significant. As an important method of multiple research and comprehensive literature analysis, Meta analysis is an evidence-based medical method to solve the multiple research reports of the same medical problem. It can be systematically, quantified and comprehensive statistical analysis of the results of the study, so that it can not only help to study the drug treatment of the disease, but also prevent and screen the disease. Epidemiological studies, etc., have important guiding significance. If the Meta analysis can be applied correctly and reasonably in clinical practice, it can provide great help for clinical work and research. Objective: This study aims to evaluate the effectiveness of various treatments of ESES by Meta analysis and to determine the value of treatment for ESES by different treatments for clinical use. Provide theoretical basis. Methods: through the Ebsco database, the Elsevier ScienceDirect database, the Medline database, the Pubmeb database, the Web of science database, the Chinese periodical full text database (CNKI), the VP database (VIP), and the Chinese biomedical literature database (CBM) to carry out the retrieval work of the literature. To evaluate the effectiveness of the ESES disease treatment, the heterogeneity analysis in each study is mainly expressed by Q test and I2 statistics. If the heterogeneity of each study is relatively large, a random effect model (random effects model, REM) is used to be combined with its efficiency, and on the contrary, a fixed effect model (fixed) is used. Effects model, FEM) to merge the statistics. The publication bias was detected by the funnel map and the data analysis was performed with Stata 13. Conclusion: the results of Meta analysis showed that the clinical effectiveness of the ketogenic diet was the lowest, and the effectiveness of surgical treatment and antiepileptic drug treatment was relatively high.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1

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