【摘要】：背景：生酮飲食(ketogenic diet, KD)是一種高脂肪,低碳水化合物,適量蛋白質(zhì)的特殊飲食,它主要是模擬人體的饑餓狀態(tài),即碳水化合物供應(yīng)不足,主要依靠脂肪類物質(zhì)供能,但是脂肪酸不能透過血腦屏障到達(dá)腦組織,但是其中間代謝產(chǎn)物酮體可轉(zhuǎn)運(yùn)至腦組織為其供能,與此同時(shí),也改變了神經(jīng)元的興奮性,發(fā)揮了抗癲癇的作用,但是具體機(jī)制尚不明確。嬰兒痙攣(IS)時(shí)一種嬰兒期起病、發(fā)作頻繁的癲癇綜合征,傳統(tǒng)的抗癲癇藥物(antiepileptic drugs,AEDs)治療效果并不理想,即使是應(yīng)用了國(guó)內(nèi)外較為推崇的促腎上腺皮質(zhì)激素(adrenocorticotrophic hormone, ACTH)治療,復(fù)發(fā)率仍在50%以上,所以近年來越來越多的治療方法被嘗試應(yīng)用于IS的治療,其中就包括KD療法。 目的：本文就K.D對(duì)于IS的治療效果、不良反應(yīng)以及可能影響療效的因素進(jìn)行研究分析,旨在為臨床醫(yī)師應(yīng)用KD治療IS提供有效的參考依據(jù)。 方法本研究篩選了2012年6月至2014年3月收治于我院的41例IS的患兒,參考霍普金斯醫(yī)院的經(jīng)典KD方案,按照我院自身情況制定的經(jīng)典KD進(jìn)行治療。入組患兒在KD開始后均進(jìn)行了至少1個(gè)月隨訪,參照Engel分級(jí)方法對(duì)療效進(jìn)行評(píng)估,癲癇發(fā)作減少50%以上認(rèn)為治療有效,有效者可分為Ⅰ級(jí)、Ⅱ級(jí)、Ⅲ級(jí),發(fā)作減少不足50%為無效。對(duì)于可能對(duì)KD治療效果產(chǎn)生的相關(guān)因素進(jìn)行了研究分析,包括性別、發(fā)病年齡、病程、KD起始比例、入組前藥物、病因、發(fā)作類型以及腦電圖情況,同時(shí)也分析了KD后的不良反應(yīng)以及智力運(yùn)動(dòng)發(fā)育的改變。結(jié)果本次研究中共有41例患兒,其中男性患兒20名,女性患兒21名,KD開始的平均年齡為25.48月±17.43(0-48),KD治療平均持續(xù)時(shí)間5.58月±3.63(1-18),入組前用藥數(shù)量平均為4.61±1.86(2-9)。隨訪1、3、6、9、12個(gè)月及以上時(shí),有效人數(shù)及占保留人數(shù)的比例分別為25(60.9%)、18(50.0%)、14(51.9%)、4(80.0%)、2(66.7%)、2(100.0%)。其中25例(60.9%)患兒運(yùn)動(dòng)智力發(fā)育水平較前提高。 在KD治療過程中,出現(xiàn)不良反應(yīng)者有29例(70.7%),其中嘔吐14例(34.1%),腹瀉16例(39.2%),便秘7例(17.1%),肺炎3例(7.3%),低血糖2例(4.9%),低蛋白血癥1例(2.4%),腎結(jié)石1例(2.4%)。 結(jié)論KD是治療IS的一種有效的方法,并且見效較迅速。添加KD飲食治療的有效率遠(yuǎn)遠(yuǎn)高于既往研究中添加第三種AEDs發(fā)作的有效率。除了能有效控制癲癇發(fā)作以外,KD也可有效提高IS患兒智力運(yùn)動(dòng)發(fā)育水平以及改善腦電圖情況。KD還是一種相對(duì)安全的治療方法。雖然不良反應(yīng)發(fā)生率較高,但是程度大部分較輕微,多數(shù)患兒可耐受治療。
[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，

本文編號(hào)：2269747