促腎上腺皮質(zhì)激素治療嬰兒痙攣癥的近期療效與遠(yuǎn)期預(yù)后及其影響因素的研究
發(fā)布時(shí)間：2019-01-19 11:37
【摘要】：目的：分析促腎上腺皮質(zhì)激素(ACTH)治療嬰兒痙攣癥的近期療效和遠(yuǎn)期預(yù)后及其影響因素，為提高嬰兒痙攣癥治療效果提供參考依據(jù)。 方法：根據(jù)診斷標(biāo)準(zhǔn)、納入標(biāo)準(zhǔn)，排除標(biāo)準(zhǔn)，建立數(shù)據(jù)庫(kù)，收集病例，隨訪，分析課題組1999-2010年間在深圳市兒童醫(yī)院確診并住院治療的嬰兒痙攣癥患兒，分首選ACTH組和非首選ACTH組，比較近期(8周內(nèi))無(wú)發(fā)作率，藥物選擇次序?qū)Πd癇發(fā)作的影響；分析ACTH治療后近期臨床無(wú)發(fā)作療效與視頻腦電圖改變相關(guān)性；分析非首選ACTH組近期療效的影響因素；分析遠(yuǎn)期預(yù)后及其影響因素。 結(jié)果：最后隨訪時(shí)間2013年12月，病例共113例。1.首選ACTH組33例，非首選ACTH組80例，首選組取得近期無(wú)發(fā)作療效21例，占63.6%，非首選組近期無(wú)發(fā)作療效33例，占41.3%。二組X2=4.69，P0.05，結(jié)果有統(tǒng)計(jì)學(xué)差異。2.113例嬰兒痙攣癥患兒均選擇ACTH治療，治療前腦電圖均有高峰節(jié)律紊亂，近期發(fā)作控制組54例，高峰節(jié)律紊亂消失38例，占70.4%；發(fā)作未控制組59例，高峰節(jié)律紊亂消失23例，占39%，二組X2=11.18，P0.05，結(jié)果有統(tǒng)計(jì)學(xué)意義。3.非首選ACTH組80例，近期痙攣發(fā)作控制33例，占41.3%，療效與起病年齡和初診年齡有關(guān)(起病年齡6月、初診年齡6月的患兒抗癲癇藥失敗后再用ACTH效果更好)，與性別、病程、病因無(wú)關(guān)；4.隨訪末期復(fù)發(fā)情況：首選ACTH組無(wú)發(fā)作21例，7例復(fù)發(fā)，復(fù)發(fā)率為33.3%；非首選ACTH組無(wú)發(fā)作33例，14例復(fù)發(fā)，復(fù)發(fā)率為42.4%，2組X2=0.78，P0.05，結(jié)果無(wú)統(tǒng)計(jì)學(xué)意義。遠(yuǎn)期發(fā)作情況：ACTH治療后完全控制無(wú)復(fù)發(fā)33例，ACTH聯(lián)合其它抗癲癇藥均未控制55例(其中7例死亡，，12例發(fā)作形式改變，包括肌陣攣發(fā)作、強(qiáng)直發(fā)作、典型或非典型失神發(fā)作、局灶性發(fā)作等)，ACTH治療后未控制但其它抗癲癇藥控制15例。5.遠(yuǎn)期智力運(yùn)動(dòng)發(fā)育好轉(zhuǎn)或正常有49例，未見(jiàn)好轉(zhuǎn)或倒退有57例。起病年齡6月、初診年齡6月、ACTH近、遠(yuǎn)期發(fā)作完全控制、病因?yàn)殡[源性的患兒智力運(yùn)動(dòng)發(fā)育更好，智力運(yùn)動(dòng)發(fā)育預(yù)后與性別、ACTH近期高峰節(jié)律紊亂消失情況無(wú)關(guān)。 結(jié)論：1.嬰兒痙攣癥首選ACTH治療可以獲得較高近期無(wú)發(fā)作率(63.6%)，對(duì)抗癲癇藥物失敗后的患兒，ACTH治療獲得無(wú)發(fā)作的機(jī)會(huì)較低(41.3%)，但仍然值得嘗試；2.視頻腦電圖監(jiān)測(cè)是判斷ACTH治療后近期療效的重要指標(biāo)，臨床“無(wú)發(fā)作”情況不能完全反映視頻腦電圖高峰節(jié)律紊亂消失情況；3.非首選ACTH近期療效：起病年齡6月、初診年齡6月的患兒抗癲癇藥失敗后再用ACTH效果更好；4.遠(yuǎn)期復(fù)發(fā)率與是否首選ACTH治療無(wú)關(guān)；5.遠(yuǎn)期預(yù)后：起病年齡6月、初診年齡6月、ACTH近期及遠(yuǎn)期發(fā)作完全控制、病因?yàn)殡[源性的患兒智力運(yùn)動(dòng)發(fā)育更好。
[Abstract]:Objective: to analyze the short term curative effect, long term prognosis and influencing factors of adrenocorticotropic hormone (ACTH) in the treatment of infantile spasticity, so as to provide reference for improving the therapeutic effect of infantile spasm. Methods: according to diagnostic criteria, inclusion criteria, exclusion criteria, establishment of database, collection of cases, follow-up, analysis of children with infantile spasticity diagnosed and hospitalized in Shenzhen Children's Hospital from 1999 to 2010. The patients were divided into the first choice ACTH group and the non first choice ACTH group. There was no seizure rate in the near future (8 weeks) and the influence of drug selection order on epileptic seizure. To analyze the correlation between the effect of clinical non-seizure after ACTH treatment and the changes of video-EEG; to analyze the influencing factors of short-term curative effect of non-first-choice ACTH group; to analyze the long-term prognosis and its influencing factors. Results: in December 2013, 113 cases were followed up. 1. 1. 33 cases of the first choice ACTH group, 80 cases of the non-preferred ACTH group, 21 cases (63.6%) of the first choice group had no attack in the short term, 33 cases (41.3%) of the non-first choice group had no recent attack effect. 2.113 cases of infantile spasm were treated with ACTH. The electroencephalogram (EEG) had peak rhythm disorder before treatment. In the control group, 54 cases had peak rhythm disorder and 38 cases had disappeared peak rhythm disorder. 70.4%; In the uncontrolled group, the peak rhythm disorder disappeared in 23 cases (39%), and in the second group, X2 + 11.18 P 0.05, the results were statistically significant (3. 3%, P 0. 05, P 0. 05). There were 80 cases of non-first-choice ACTH group, 33 cases (41.3%) had recent spasm control. The curative effect was related to the age of onset and the age of first visit (the age of onset was 6 months, the effect of ACTH was better after the failure of antiepileptic drug in the first six months), and the effect of ACTH was better than that of sex. The course of disease was not related to the etiology. 4. At the end of follow-up, 21 cases had no attack, 7 cases recurred with a recurrence rate of 33.3% in the first choice ACTH group, and 33 cases (14 cases) recurred in the non-preferred ACTH group, and the recurrence rate was 42.4% (P 0.05). Long-term seizure: after ACTH treatment, 33 cases were completely controlled without recurrence, 55 cases were not controlled by ACTH combined with other antiepileptic drugs (7 cases died, 12 cases had changes of seizure form, including myoclonic seizure, tonic attack, typical or atypical aphasia, etc. 15 cases were controlled by other antiepileptic drugs, but 15 cases were not controlled after), ACTH treatment. 5. 5%. There were 49 cases with improved or normal intellectual motor development, 57 cases without improvement or regression. The onset age was 6 months, the first diagnosis age was 6 months, the ACTH was near, the long term attack was completely controlled, the cause of the disease was the better intellectual motor development of the children with cryptic origin, the prognosis of the intellectual motor development was not related to the sex, and the disordered peak rhythm of ACTH disappeared in the near future. Conclusion: 1. The first choice of ACTH treatment for infantile spasm can obtain a higher rate of short term non-seizure (63.6%), but the chance of ACTH treatment is lower (41.3%) after the failure of antiepileptic drugs, but it is still worth trying; 2. Video EEG monitoring is an important index to judge the short-term curative effect after ACTH treatment. Clinical "no attack" can not completely reflect the disappearance of peak rhythm disorder of video EEG. 3. The short term efficacy of non first choice ACTH: the onset of the disease in 6 months, the first six months of age after the failure of antiepileptic drugs after the use of ACTH is better; 4. The long term recurrence rate was not related to the first choice of ACTH treatment. Long term prognosis: the onset age was 6 months, the first visit age was 6 months, the short and long term attack of ACTH was completely controlled, and the cause of the disease was the better intellectual motor development of the children whose etiology was cryptogenic.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R742.1
本文編號(hào)：2411339
[Abstract]:Objective: to analyze the short term curative effect, long term prognosis and influencing factors of adrenocorticotropic hormone (ACTH) in the treatment of infantile spasticity, so as to provide reference for improving the therapeutic effect of infantile spasm. Methods: according to diagnostic criteria, inclusion criteria, exclusion criteria, establishment of database, collection of cases, follow-up, analysis of children with infantile spasticity diagnosed and hospitalized in Shenzhen Children's Hospital from 1999 to 2010. The patients were divided into the first choice ACTH group and the non first choice ACTH group. There was no seizure rate in the near future (8 weeks) and the influence of drug selection order on epileptic seizure. To analyze the correlation between the effect of clinical non-seizure after ACTH treatment and the changes of video-EEG; to analyze the influencing factors of short-term curative effect of non-first-choice ACTH group; to analyze the long-term prognosis and its influencing factors. Results: in December 2013, 113 cases were followed up. 1. 1. 33 cases of the first choice ACTH group, 80 cases of the non-preferred ACTH group, 21 cases (63.6%) of the first choice group had no attack in the short term, 33 cases (41.3%) of the non-first choice group had no recent attack effect. 2.113 cases of infantile spasm were treated with ACTH. The electroencephalogram (EEG) had peak rhythm disorder before treatment. In the control group, 54 cases had peak rhythm disorder and 38 cases had disappeared peak rhythm disorder. 70.4%; In the uncontrolled group, the peak rhythm disorder disappeared in 23 cases (39%), and in the second group, X2 + 11.18 P 0.05, the results were statistically significant (3. 3%, P 0. 05, P 0. 05). There were 80 cases of non-first-choice ACTH group, 33 cases (41.3%) had recent spasm control. The curative effect was related to the age of onset and the age of first visit (the age of onset was 6 months, the effect of ACTH was better after the failure of antiepileptic drug in the first six months), and the effect of ACTH was better than that of sex. The course of disease was not related to the etiology. 4. At the end of follow-up, 21 cases had no attack, 7 cases recurred with a recurrence rate of 33.3% in the first choice ACTH group, and 33 cases (14 cases) recurred in the non-preferred ACTH group, and the recurrence rate was 42.4% (P 0.05). Long-term seizure: after ACTH treatment, 33 cases were completely controlled without recurrence, 55 cases were not controlled by ACTH combined with other antiepileptic drugs (7 cases died, 12 cases had changes of seizure form, including myoclonic seizure, tonic attack, typical or atypical aphasia, etc. 15 cases were controlled by other antiepileptic drugs, but 15 cases were not controlled after), ACTH treatment. 5. 5%. There were 49 cases with improved or normal intellectual motor development, 57 cases without improvement or regression. The onset age was 6 months, the first diagnosis age was 6 months, the ACTH was near, the long term attack was completely controlled, the cause of the disease was the better intellectual motor development of the children with cryptic origin, the prognosis of the intellectual motor development was not related to the sex, and the disordered peak rhythm of ACTH disappeared in the near future. Conclusion: 1. The first choice of ACTH treatment for infantile spasm can obtain a higher rate of short term non-seizure (63.6%), but the chance of ACTH treatment is lower (41.3%) after the failure of antiepileptic drugs, but it is still worth trying; 2. Video EEG monitoring is an important index to judge the short-term curative effect after ACTH treatment. Clinical "no attack" can not completely reflect the disappearance of peak rhythm disorder of video EEG. 3. The short term efficacy of non first choice ACTH: the onset of the disease in 6 months, the first six months of age after the failure of antiepileptic drugs after the use of ACTH is better; 4. The long term recurrence rate was not related to the first choice of ACTH treatment. Long term prognosis: the onset age was 6 months, the first visit age was 6 months, the short and long term attack of ACTH was completely controlled, and the cause of the disease was the better intellectual motor development of the children whose etiology was cryptogenic.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R742.1
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