生酮饮食添加治疗儿童难治性癫痫的临床研究

发布时间：2018-05-11 09:54

本文选题：生酮饮食 + 儿童　；参考：《郑州大学》2014年硕士论文

【摘要】：目的观察生酮饮食（ketogenic diet，KD）添加治疗儿童难治性癫痫的临床疗效、保留率、不良反应、脑电图变化及其对认知功能的影响，并比较住院治疗组与门诊治疗组KD不同实施方案的临床疗效及保留率，以期探寻更加适合中国难治性癫痫患儿的KD治疗特点。方法研究对象为自2012年5月至2013年8月在郑州大学第三附属医院儿童脑瘫康复科接受KD添加治疗的36例难治性癫痫患者，包括住院治疗组20例及门诊治疗组16例，住院治疗组患儿年龄8～63个月，年龄中位数是41个月，患儿KD添加治疗前病程6～57个月，病程中位数42个月。住院治疗组KD治疗方案采用经典模式：启用时禁食，脂肪和蛋白质、碳水化合物比例为4:1；门诊治疗组患儿年龄10～58个月，年龄中位数是40个月，，患儿KD添加治疗前病程9～50个月，病程中位数43.6个月。门诊治疗组KD治疗方案为不禁食，脂肪和蛋白质、碳水化合物比例由1:1逐渐增高至4:1。两组癫痫发作类型包括典型及非典型失神发作、癫痫性痉挛发作、肌阵挛发作、强直发作、阵挛发作、强直-阵挛发作及部分性发作，每个患儿有一种或多种发作类型。所有患者KD添加治疗3个月内原用抗癫痫药物种类与用量保持不变。疗效的评估以KD添加治疗前癫痫发作频率为基线，通过家长的癫痫日记，记录癫痫发作的频率、类型、每次发作持续时间、发作程度变化,并于添加KD治疗后1、2、3、6、12个月门诊复诊，复查泌尿系彩超、血脂及肝肾功，添加KD治疗前及KD治疗3、6、12个月行24小时视频脑电图（24h V-EEG）检查及Gesell发育量表（包括总发育商和五大能区发育商）评定。结果 1.住院治疗组KD治疗3、6、12个月总有效率分别为60%、45%、40%，保留率分别为80%、55%、40%，完全控制率30%；门诊治疗组3、6、12个月总有效率分别为37.5%、25%、18.8%，保留率分别为62.5%、37.5%、18.8%，完全控制率12.5%； 2.住院治疗组与门诊治疗组临床疗效比较（P0.05）差异有统计学意义，保留率比较（P0.05）差异无统计学意义； 3.住院治疗组短期不良反应主要表现为胃肠道反应5例（25%），低血糖3例（15%），发热2例（10%），长期不良反应肾结石1例（5%），急性感染1例（5%）；门诊治疗组不良反应多轻微，胃肠道反应2例（13%），发热1例（6%）； 4.36例难治性癫痫患儿24h V-EEG改善共10例（27.8%），包括临床有效患儿8例（22.2%）（EEG改善达a、b、c级者分别为1例、3例、4例）和临床无效患儿2例（5.6%（）EEG改善达b、c级者各1例），其中住院治疗组7例（19.4%），门诊治疗组3例（8.3%）； 5.认知功能改善共9例（25%），其中住院治疗组6例（16.7%），门诊治疗组3例（8.3%），改善能区主要在大运动及适应性能区。结论 1.KD添加治疗儿童难治性癫痫住院治疗组与门诊治疗组两种实施方案都安全有效； 2.住院治疗组的临床疗效较门诊治疗组好，两组保留率无明显差异； 3.提高患儿依从性也是维持KD治疗的重要因素； 4.KD治疗可以改善患儿（包括临床有效患儿和临床无效患儿）24h V-EEG，治疗时间越长，改善越著，临床有效患儿EEG改善较临床无效者明显； 5.KD治疗对难治性癫痫患儿认知功能有所改善，短时间内改善主要在大运动及适应性能区。
[Abstract]:Purpose

To observe the clinical curative effect , retention rate , adverse reaction , EEG changes and their influence on cognitive function in children with refractory epilepsy .

method

Thirty - six patients with refractory epilepsy who were treated with KD from May 2012 to August 2013 at the Third Affiliated Hospital of Zhengzhou University , including 20 patients with hospitalization and 16 patients in outpatient treatment group , were aged from 8 to 63 months . The median age was 42 months .
The age of children in outpatient treatment group was 10 - 58 months . The median age was 40 months . The number of patients with KD was from 1 : 1 to 4 : 1 from 9 to 50 months .

Results

1 . The total effective rate was 60 % , 45 % , 40 % , retention rate was 80 % , 55 % , 40 % , and the complete control rate was 30 % .
The total effective rates of 3 , 6 and 12 months were 37.5 % , 25 % , 18.8 % , 62.5 % , 37.5 % , 18.8 % , 12.5 % respectively .

2 . There was no significant difference between the treatment group and the outpatient treatment group ( P0.05 ) .

3 . The short - term adverse reaction of the hospitalization group mainly manifested as 5 cases ( 25 % ) of gastrointestinal reaction , 3 cases of hypoglycemia ( 15 % ) , 2 cases of fever ( 10 % ) , 1 case of long - term adverse reaction renal calculus ( 5 % ) and 1 case of acute infection ( 5 % ) .
Adverse reactions in outpatient treatment group were mild , gastrointestinal reaction in 2 cases ( 13 % ) , fever in 1 case ( 6 % ) ;

4.36 cases of refractory epilepsy treated with V - EEG were improved in 10 cases ( 27 . 8 % ) , including 8 cases ( 22.2 % ) of clinically effective children ( 1 case of EEG improvement , 3 cases , 4 cases ) and 2 cases of clinically invalid children ( 5.6 % , respectively ) . Among them , 7 cases ( 19.4 % ) were in the hospitalization group and 3 cases ( 8.3 % ) in the outpatient treatment group ;

5 . The cognitive function improved in 9 cases ( 25 % ) , among which 6 cases ( 16.7 % ) were in - hospital treatment group and 3 cases ( 8.3 % ) in outpatient treatment group .

Conclusion

1 . KD was safe and effective in treatment group and outpatient treatment group .

2 . The clinical curative effect of the hospitalization group was better than the outpatient treatment group , and there was no significant difference between the two groups .

3 . Improving the compliance of children is also an important factor in the maintenance of KD treatment .

4 . KD treatment can improve the 24 - hour V - EEG of children ( including clinically effective children and clinically ineffective children ) , the longer the treatment time , the better the improvement is , and the improvement of EEG in clinically effective children is obvious ;

5 . KD treatment improved cognitive function in children with refractory epilepsy , and improved mainly in large and adaptive areas for a short time .

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.1

【参考文献】