CAJ | 학술논문

目的：探讨甲泼尼龙冲击治疗儿童睡眠中癫痫性电持续状态(ESES)的临床疗效。方法选择2008年1月至2013年1月于山东省鄄城县第二人民医院收治的56例 ESES 儿童为研究对象。将其按照数字表随机分组法分为实验组(n=28)和对照组(n=28)。给予对照组患儿常规抗癫痫药物治疗,实验组在对照组治疗基础上给予甲泼尼龙15 mg/(kg·d),治疗3 d 后停药4 d,连续治疗3周,之后给予甲泼尼龙1.5~2.0 mg/(kg·d)晨起顿服给药方式,4周后逐渐减量,根据患儿情况总疗程为4~6个月。治疗6个月后,观察两组患儿的临床疗效及总有效率、不良反应率及脑电图(EEG)改善情况。本研究遵循的程序符合山东省鄄城县第二人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与其签署临床研究知情同意书。两组患儿年龄、性别、ESES 病程及严重程度等比较,差异无统计学意义(P >0.05)。结果实验组显效率及总有效率均略微高于对照组,但差异均无统计学意义(χ2=0.49,1.95；P >0.05)；实验组患儿 EEG 改善的显效率及总有效率均显著高于对照组,差异均有统计学意义(χ2=11.02,7.79；P <0.01)。对照组未见与治疗相关的不良反应发生；实验组治疗过程中出现的轻微不良反应,经对症治疗消失。结论甲泼尼龙冲击治疗可减少 ESES 患儿癫痫发作,同时可改善EEG 放电,联合抗癫痫药物治疗可提高临床疗效。
목적：탐토갑발니룡충격치료인동수면중전간성전지속상태(ESES)적림상료효。방법선택2008년1월지2013년1월우산동성견성현제이인민의원수치적56례 ESES 인동위연구대상。장기안조수자표수궤분조법분위실험조(n=28)화대조조(n=28)。급여대조조환인상규항전간약물치료,실험조재대조조치료기출상급여갑발니룡15 mg/(kg·d),치료3 d 후정약4 d,련속치료3주,지후급여갑발니룡1.5~2.0 mg/(kg·d)신기돈복급약방식,4주후축점감량,근거환인정황총료정위4~6개월。치료6개월후,관찰량조환인적림상료효급총유효솔、불량반응솔급뇌전도(EEG)개선정황。본연구준순적정서부합산동성견성현제이인민의원인체시험위원회제정적윤리학표준,득도해위원회비준,분조정득수시대상감호인적지정동의,병여기첨서림상연구지정동의서。량조환인년령、성별、ESES 병정급엄중정도등비교,차이무통계학의의(P >0.05)。결과실험조현효솔급총유효솔균략미고우대조조,단차이균무통계학의의(χ2=0.49,1.95；P >0.05)；실험조환인 EEG 개선적현효솔급총유효솔균현저고우대조조,차이균유통계학의의(χ2=11.02,7.79；P <0.01)。대조조미견여치료상관적불량반응발생；실험조치료과정중출현적경미불량반응,경대증치료소실。결론갑발니룡충격치료가감소 ESES 환인전간발작,동시가개선EEG 방전,연합항전간약물치료가제고림상료효。
Objective To investigate the clinical curative effect about methylprednisolone pulse therapy on children with electrical status epilepticus during sleep (ESES).Methods From January 2008 to January 2013,a total of 56 children with ESES were recruited.According to the random number table method they were divided into experimental group (n=28)and control group (n=28).Children with ESES in control group received routine treatment only by antiepileptic drugs, and children with ESES in experimental group received combined therapy by routine antiepileptic drugs and methylprednisolone pulse therapy. Methylprednisolone pulse therapy regimen was methylprednisolone 1 5 mg/(kg · d ), oral application for three days and stop using it for four days,continuous treatment for three weeks.After 6 months of treatment,clinical efficacy,adverse reactions and improvement of electroencephalogram(EEG) were observed between two groups.The study protocol was approved by the Ethical Review Board of Investigation in Second People′s Hospital of Juancheng County in Shandong Province.Informed consent was obtained from the parents of each participant.There were no significant differences between two groups among gender,age,the duration and severity of ESES,et al (P > 0.05 ).Results Effective rate and total effective rate in experimental group were slightly higher than those in control group,but there were no significant differences (P >0.05).Response rate and total effective rate of improvement discharges of EEG in experimental group were much higher than those in control group,and there were significant differences between two groups (P <0.01 ),but there were no significant differences between two groups in effective rate of improvement of EEG (P >0.05).There were no treatment-related adverse reaction in control group. There were slight adverse reactions during treatment in experimental group, and after symptomatic treatment they were disappeared.Conclusions Methylprednisolone pulse therapy on children with ESES can reduce seizures of epilepsy and its discharges in EEG.Methylprednisolone pulse therapy combined with antiepileptic drugs can improve the clinical efficacy of children with ESES.