生酮饮食治疗婴儿痉挛症的临床研究
发布时间：2018-10-13 20:05
【摘要】：背景：生酮饮食(ketogenic diet, KD)是一种高脂肪,低碳水化合物,适量蛋白质的特殊饮食,它主要是模拟人体的饥饿状态,即碳水化合物供应不足,主要依靠脂肪类物质供能,但是脂肪酸不能透过血脑屏障到达脑组织,但是其中间代谢产物酮体可转运至脑组织为其供能,与此同时,也改变了神经元的兴奋性,发挥了抗癫痫的作用,但是具体机制尚不明确。婴儿痉挛(IS)时一种婴儿期起病、发作频繁的癫痫综合征,传统的抗癫痫药物(antiepileptic drugs,AEDs)治疗效果并不理想,即使是应用了国内外较为推崇的促肾上腺皮质激素(adrenocorticotrophic hormone, ACTH)治疗,复发率仍在50%以上,所以近年来越来越多的治疗方法被尝试应用于IS的治疗,其中就包括KD疗法。 目的：本文就K.D对于IS的治疗效果、不良反应以及可能影响疗效的因素进行研究分析,旨在为临床医师应用KD治疗IS提供有效的参考依据。 方法本研究筛选了2012年6月至2014年3月收治于我院的41例IS的患儿,参考霍普金斯医院的经典KD方案,按照我院自身情况制定的经典KD进行治疗。入组患儿在KD开始后均进行了至少1个月随访,参照Engel分级方法对疗效进行评估,癫痫发作减少50%以上认为治疗有效,有效者可分为Ⅰ级、Ⅱ级、Ⅲ级,发作减少不足50%为无效。对于可能对KD治疗效果产生的相关因素进行了研究分析,包括性别、发病年龄、病程、KD起始比例、入组前药物、病因、发作类型以及脑电图情况,同时也分析了KD后的不良反应以及智力运动发育的改变。结果本次研究中共有41例患儿,其中男性患儿20名,女性患儿21名,KD开始的平均年龄为25.48月±17.43(0-48),KD治疗平均持续时间5.58月±3.63(1-18),入组前用药数量平均为4.61±1.86(2-9)。随访1、3、6、9、12个月及以上时,有效人数及占保留人数的比例分别为25(60.9%)、18(50.0%)、14(51.9%)、4(80.0%)、2(66.7%)、2(100.0%)。其中25例(60.9%)患儿运动智力发育水平较前提高。 在KD治疗过程中,出现不良反应者有29例(70.7%),其中呕吐14例(34.1%),腹泻16例(39.2%),便秘7例(17.1%),肺炎3例(7.3%),低血糖2例(4.9%),低蛋白血症1例(2.4%),肾结石1例(2.4%)。 结论KD是治疗IS的一种有效的方法,并且见效较迅速。添加KD饮食治疗的有效率远远高于既往研究中添加第三种AEDs发作的有效率。除了能有效控制癫痫发作以外,KD也可有效提高IS患儿智力运动发育水平以及改善脑电图情况。KD还是一种相对安全的治疗方法。虽然不良反应发生率较高,但是程度大部分较轻微,多数患儿可耐受治疗。
[Abstract]:Background: ketone diet (ketogenic diet, KD) is a special diet with high fat, low carbohydrate and moderate amount of protein. It mainly simulates the hunger of human body, that is, the supply of carbohydrates is insufficient, and it mainly depends on fatty substances for energy supply. But fatty acids can't get through the blood-brain barrier to the brain, but their intermediate metabolites, ketones, can be transported to the brain to feed them. At the same time, they also change the excitability of neurons and play an antiepileptic role. However, the specific mechanism is not clear. Infantile spastic (IS) is a kind of infantile epilepsy syndrome with frequent seizures. Traditional antiepileptic drugs (antiepileptic drugs,AEDs) are not effective, even if the adrenocorticotropic hormone (adrenocorticotrophic hormone, ACTH) is used in the treatment of infantile spasms, such as adrenocorticotropic hormone (adrenocorticotrophic hormone, ACTH). The recurrence rate is still over 50%, so in recent years more and more treatments have been tried for IS, including KD therapy. Objective: to study and analyze the therapeutic effects, adverse reactions and possible factors affecting the efficacy of K.D for IS, in order to provide an effective reference for clinicians to use KD in the treatment of IS. Methods from June 2012 to March 2014, 41 patients with IS were selected and treated according to the classical KD regimen of Hopkins Hospital. All the children in the group were followed up for at least one month after the onset of KD. According to the Engel grading method, the curative effect was evaluated. The epileptic seizures were reduced by more than 50%, and the patients who were effective could be classified as grade 鈪，
本文编号：2269747
[Abstract]:Background: ketone diet (ketogenic diet, KD) is a special diet with high fat, low carbohydrate and moderate amount of protein. It mainly simulates the hunger of human body, that is, the supply of carbohydrates is insufficient, and it mainly depends on fatty substances for energy supply. But fatty acids can't get through the blood-brain barrier to the brain, but their intermediate metabolites, ketones, can be transported to the brain to feed them. At the same time, they also change the excitability of neurons and play an antiepileptic role. However, the specific mechanism is not clear. Infantile spastic (IS) is a kind of infantile epilepsy syndrome with frequent seizures. Traditional antiepileptic drugs (antiepileptic drugs,AEDs) are not effective, even if the adrenocorticotropic hormone (adrenocorticotrophic hormone, ACTH) is used in the treatment of infantile spasms, such as adrenocorticotropic hormone (adrenocorticotrophic hormone, ACTH). The recurrence rate is still over 50%, so in recent years more and more treatments have been tried for IS, including KD therapy. Objective: to study and analyze the therapeutic effects, adverse reactions and possible factors affecting the efficacy of K.D for IS, in order to provide an effective reference for clinicians to use KD in the treatment of IS. Methods from June 2012 to March 2014, 41 patients with IS were selected and treated according to the classical KD regimen of Hopkins Hospital. All the children in the group were followed up for at least one month after the onset of KD. According to the Engel grading method, the curative effect was evaluated. The epileptic seizures were reduced by more than 50%, and the patients who were effective could be classified as grade 鈪，
本文编号：2269747
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