中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2013年
4期
276-282
,共7页
前瞻性研究%生酮饮食%难治性癫(癎)%儿童
前瞻性研究%生酮飲食%難治性癲(癎)%兒童
전첨성연구%생동음식%난치성전(간)%인동
Prospective studies%Ketogenic diet%Intractable epilepsy%Child
目的 了解长期生酮饮食(ketogenic diet,KD)治疗儿童难治性癫(癎)的疗效和安全性.方法 采用前瞻性研究设计,对国内5家医院儿科癫(癎)中心2004年10月至2011年7月采用经典4∶1 KD[脂肪:(葡萄糖+蛋白)质量比为4∶1]治疗的299例难治性癫(癎)患儿,男189例,女110例,根据年龄(＜1岁、～3岁、～6岁、～10岁、＞10岁)、癫(癎)病因(隐源性、症状性、原发性)和类型(婴儿痉挛症、Lennox-Gastaut综合征、大田原综合征、结节性硬化症、Dravet综合征、全面性癫(癎)、部分性癫(癎))进行分组.KD启动后,家长须记录每日发作情况(包括发作形式、频率和严重程度等)、对KD的耐受性以及并发症,每周测量体重、身高,定期监测血β羟丁酸、血糖、尿酮体.每个月对患儿进行电话随访,第3、6、12个月到医院随访,复查身高、体重、血生化、泌尿系统超声、脑电图和骨骼发育情况等.用SPSS17.0软件统计分析各组的保留率(即继续接受治疗的比率)和发作改善情况.结果 KD治疗后3、6、12个月,分别有197例(65.9％)、134例(44.8％)和79例(26.4％)继续接受KD治疗,其中37例(12.4％)、28例(9.4％)和16例(5.4％)发作次数减少50％ ～ 90％,75例(25.1％)、50例(16.7％)和45例(15.1％)发作减少＞90％,包括65例(21.7％)、32例(10.7％)和33例(11.0％)无发作.有效率(发作减少＞50％)分别为37.1％、26.1％和20.4％.不到3个月即终止KD治疗的患儿102例(34.1％),其中33例KD治疗时间不足1个月(11.0％).24个月时,29例继续接受治疗,其中28例发作减少＞90％,包括24例无发作.36个月时,7例保留,发作减少均＞90％,其中5例无发作.KD对不同类型或不同年龄组难治性癫(癎)的疗效差异无统计学意义.大部分并发症轻微,且可保守治疗缓解,其中,胃肠道功能紊乱(包括呕吐、腹泻、便秘、腹痛等)是最常见的并发症,仅4例患儿出现严重并发症,包括严重代谢紊乱,重症肺炎.结论 KD对儿童难治性癫(癎)有一定的治疗作用,且较为安全.
目的 瞭解長期生酮飲食(ketogenic diet,KD)治療兒童難治性癲(癎)的療效和安全性.方法 採用前瞻性研究設計,對國內5傢醫院兒科癲(癎)中心2004年10月至2011年7月採用經典4∶1 KD[脂肪:(葡萄糖+蛋白)質量比為4∶1]治療的299例難治性癲(癎)患兒,男189例,女110例,根據年齡(＜1歲、～3歲、～6歲、～10歲、＞10歲)、癲(癎)病因(隱源性、癥狀性、原髮性)和類型(嬰兒痙攣癥、Lennox-Gastaut綜閤徵、大田原綜閤徵、結節性硬化癥、Dravet綜閤徵、全麵性癲(癎)、部分性癲(癎))進行分組.KD啟動後,傢長鬚記錄每日髮作情況(包括髮作形式、頻率和嚴重程度等)、對KD的耐受性以及併髮癥,每週測量體重、身高,定期鑑測血β羥丁痠、血糖、尿酮體.每箇月對患兒進行電話隨訪,第3、6、12箇月到醫院隨訪,複查身高、體重、血生化、泌尿繫統超聲、腦電圖和骨骼髮育情況等.用SPSS17.0軟件統計分析各組的保留率(即繼續接受治療的比率)和髮作改善情況.結果 KD治療後3、6、12箇月,分彆有197例(65.9％)、134例(44.8％)和79例(26.4％)繼續接受KD治療,其中37例(12.4％)、28例(9.4％)和16例(5.4％)髮作次數減少50％ ～ 90％,75例(25.1％)、50例(16.7％)和45例(15.1％)髮作減少＞90％,包括65例(21.7％)、32例(10.7％)和33例(11.0％)無髮作.有效率(髮作減少＞50％)分彆為37.1％、26.1％和20.4％.不到3箇月即終止KD治療的患兒102例(34.1％),其中33例KD治療時間不足1箇月(11.0％).24箇月時,29例繼續接受治療,其中28例髮作減少＞90％,包括24例無髮作.36箇月時,7例保留,髮作減少均＞90％,其中5例無髮作.KD對不同類型或不同年齡組難治性癲(癎)的療效差異無統計學意義.大部分併髮癥輕微,且可保守治療緩解,其中,胃腸道功能紊亂(包括嘔吐、腹瀉、便祕、腹痛等)是最常見的併髮癥,僅4例患兒齣現嚴重併髮癥,包括嚴重代謝紊亂,重癥肺炎.結論 KD對兒童難治性癲(癎)有一定的治療作用,且較為安全.
목적 료해장기생동음식(ketogenic diet,KD)치료인동난치성전(간)적료효화안전성.방법 채용전첨성연구설계,대국내5가의원인과전(간)중심2004년10월지2011년7월채용경전4∶1 KD[지방:(포도당+단백)질량비위4∶1]치료적299례난치성전(간)환인,남189례,녀110례,근거년령(＜1세、～3세、～6세、～10세、＞10세)、전(간)병인(은원성、증상성、원발성)화류형(영인경련증、Lennox-Gastaut종합정、대전원종합정、결절성경화증、Dravet종합정、전면성전(간)、부분성전(간))진행분조.KD계동후,가장수기록매일발작정황(포괄발작형식、빈솔화엄중정도등)、대KD적내수성이급병발증,매주측량체중、신고,정기감측혈β간정산、혈당、뇨동체.매개월대환인진행전화수방,제3、6、12개월도의원수방,복사신고、체중、혈생화、비뇨계통초성、뇌전도화골격발육정황등.용SPSS17.0연건통계분석각조적보류솔(즉계속접수치료적비솔)화발작개선정황.결과 KD치료후3、6、12개월,분별유197례(65.9％)、134례(44.8％)화79례(26.4％)계속접수KD치료,기중37례(12.4％)、28례(9.4％)화16례(5.4％)발작차수감소50％ ～ 90％,75례(25.1％)、50례(16.7％)화45례(15.1％)발작감소＞90％,포괄65례(21.7％)、32례(10.7％)화33례(11.0％)무발작.유효솔(발작감소＞50％)분별위37.1％、26.1％화20.4％.불도3개월즉종지KD치료적환인102례(34.1％),기중33례KD치료시간불족1개월(11.0％).24개월시,29례계속접수치료,기중28례발작감소＞90％,포괄24례무발작.36개월시,7례보류,발작감소균＞90％,기중5례무발작.KD대불동류형혹불동년령조난치성전(간)적료효차이무통계학의의.대부분병발증경미,차가보수치료완해,기중,위장도공능문란(포괄구토、복사、편비、복통등)시최상견적병발증,부4례환인출현엄중병발증,포괄엄중대사문란,중증폐염.결론 KD대인동난치성전(간)유일정적치료작용,차교위안전.
Objective To evaluate the efficacy and safety of long-term ketogenic diet (KD) on the children with intractable epilepsy.Method This was a prospective,open-label study of intractable epilepsy patients treated with the classic KD with a lipid-to-nonlipid ratio 4:1 between October 2004 and July 2011 at five Chinese epilepsy centers.A total of 299 patients were enrolled.The patients were divided into different groups according to age (including the below-l-year-old group,1-to-3-year-old group,3-to-6-year-old group,6-to-10-year-old group,and over-10-year-old group),etiology (cryptogenic epilepsy,symptomatic epilepsy,and idiopathic epilepsy),and the seizure types (included infantile spasm,Lennox-Gastaut syndrome,Ohtahara syndrome,tuberous sclerosis,Dravet syndrome,generalized epilepsy,and partial epilepsy).Parents were assigned to write seizure diaries which recorded the seizure presentations,tolerability,and complications associated with the KD.Patients' weight and height were measured every week.Blood β-hydroxybutyric acid,blood sugar,and urinary ketone bodies were monitored closely.Patients were followed up through telephone calls hy the nutritionists every month and regular outpatient visits or hospitalizations were recommended at all time-points which included the third,sixth and twelfth month after initiation.Efficacy was measured through seizure frequency.The variables related to the efficacy were also analyzed.SPSS 17.0 was used for all statistical analysis.Result At 3,6,and 12 months after initiation,65.9％,44.8％,and 26.4％ patients remained on the diet,and 37.4％,26.1％,and 20.4％ had a ＞50％ reduction in their seizure frequency,including 21.7％,10.7％,and l l.0% who became seizure free,respectively.At 24 months after initiation,29 patients remained on the diet,and 28 patients had a ＞90％ seizure reduction,including five became seizure free.At 36 months after initiation,7 patients remained on the diet,and all of them had a ＞ 90％ seizure reduction,including five became seizure free.No significant variables were related to the efficacy.Most complications were mild and reversible by conservative treatment.Gastrointestinal disturbances were the main complications,which included vomiting,diarrhea,constipation,and abdominal cramp.Severe complications occurred in four cases,including severe metabolic disturbances and severe pneumonia.Conclusion The KD is a safe and effective alternative therapy for intractable childhood epilepsy.
