中国实用儿科杂志

中国实用儿科杂志 ›› 2012, Vol. 27 ›› Issue (11): 856-859.

• 论著 • 上一篇    下一篇

不同剂量促肾上腺皮质激素治疗婴儿痉挛回顾性研究

  

  1. 北京大学第一医院儿科，北京    100034
  • 出版日期:2012-11-06 发布日期:2012-11-27

Retrospective study of different doses of ACTH therapy for infantile spasms. 

  1. Pediatric Department，Peking University First Hospital，Beijing100034，China
  • Online:2012-11-06 Published:2012-11-27

摘要：

摘要：目的    总结婴儿痉挛（infantile spasms，IS）临床特点，比较不同剂量促肾上腺皮质激素（ACTH）治疗IS短期疗效、副反应，探讨临床痉挛发作缓解的影响因素。方法    对2005年1月至2010年12月北京大学第一医院儿科住院并首次行ACTH治疗的IS患儿病历资料进行回顾性研究。按起始ACTH治疗剂量不同分为大剂量组、小剂量组，比较两组临床及脑电图疗效、副反应，采用Logistic回归分析评价临床疗效的影响因素。结果    共收集198例临床资料、脑电图特点及影像学特征。大剂量组IS患儿痉挛发作缓解率为37.3%（25/67），小剂量组45.0%（59/131），差异无统计学意义（P＞0.05）。120例治疗结束后复查录像脑电图，大剂量组高度失律消失率42.2%（19/45），小剂量组58.7%（44/75），差异无统计学意义（P＞0.05）。两组不同剂量应用ACTH期间副反应发生率分别为52.2%（35/67）和32.8%（43/131），差异有统计学意义（P＜0.05）。ACTH治疗前病程（treatment lag，TL）是影响短期ACTH疗效的独立危险因素，TL≤1个月者痉挛发作缓解率59.0%（36/61），TL＞1个月者痉挛发作缓解率34.8%（48/137），差异有统计学意义（P＜0.05）。结论    大剂量与小剂量ACTH对痉挛发作缓解率、脑电图高度失律消失率差异无统计学意义（P＞0.05）；大剂量ACTH副反应显著多于小剂量；TL是影响短期ACTH疗效的独立危险因素。

关键词: 婴儿痉挛, 促肾上腺皮质激素, 剂量

Abstract:

Abstract：Objective    To summarize clinical characteristics of infantile spasms（IS）， to compare the short-term efficacy and side effects of high-dose and low-dose ACTH therapy，and to investigate influencing factors on the resolution of spasms. Methods    Clinical data of IS patients who were treated with ACTH for the first time were investigated retrospectively.These patients were admitted to Peking University First Hospital from January 2005 to December 2010.These patients were divided into high-dose and low-dose groups according to initial ACTH doses.Clinical efficacy on spasms， resolution of hypsarrythmia and side effects were compared between these two groups.Logistic regression was used to explore risk factors for clinical control of spasms. Results    A total of 198 patients were included into the study. Their clinical data，EEG characteristics and brain imaging were fully investigated.Complete cessation of spasms was achieved in 37.3%（25/67） of the high-dose group and 45.0%（59/131） of the low-dose group.No significant difference was found between these two groups. EEG was reevaluated in 120 patients after ACTH therapy.In the high-dose group hypsarrythmia disappeared in 42.2%（19/45） of the patients，and 58.7%（44/75） in the low-dose group， no significant difference on the resolution of hypsarrythmia was seen between the two groups. In the high-dose group， 52.2%（35/67）of patients experienced side effects of ACTH while it was 32.8%（43/131） in the low-dose group，the difference being significant between the two groups. Treatment lag（TL），defined as the time from onset of spasms to the initiation of ACTH treatment， was an independent risk factor for the cessation of spasms.About 59.0%（36/61） of patients with TL no more than 1 month achieved cessation of spasms；as for patients with TL longer than 1 month， the cessation of spasms occurred in 34.8%（48/137） . The difference was significant between the two groups. Conclusions    The study shows similar efficacy between different doses of ACTH on cessation of spasms， and on resolution of hypsarrhythmia. High-dose ACTH has more side effects compared with low-dose one.Treatment lag is an independent risk factor for the cessation of spasms.

Key words: infantile spasms, ACTH, dose

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