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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。
Objective To summarize the clinical features of infantile spasms (IS) and compare the short-term effects and side effects of different doses of adrenocorticotrophic hormone (ACTH) in treating seizures. Methods A retrospective study was conducted on pediatric IS data from January 2005 to December 2010 in Peking University First Hospital and the first ACTH treatment. According to the initial dose of ACTH treatment is divided into high-dose group, low-dose group, the clinical and EEG efficacy and side effects were compared between two groups, using Logistic regression analysis to evaluate the influencing factors of clinical efficacy. Results A total of 198 cases of clinical data collected, EEG characteristics and imaging features. The remission rate of spastic seizure was 37.3% (25/67) in high dose group and 45.0% (59/131) in low dose group, the difference was not statistically significant (P> 0.05). EEG was recorded after 120 cases of treatment. The high rate of disappearance of the high dose group was 42.2% (19/45) in the high dose group and 58.7% (44/75) in the low dose group. The difference was not statistically significant (P> 0.05). The incidence of side effects of ACTH with two different dosages was 52.2% (35/67) and 32.8% (43/131), respectively, with significant difference (P <0.05). Treatment lag (TL) before ACTH was an independent risk factor for short-term ACTH. The remission rate of spastic seizures was 59.0% (36/61) in TL≤1 months, and the remission rate of spastic seizures was 34.8% (48/137), the difference was statistically significant (P <0.05). Conclusions There is no significant difference in the rate of eversion of high-dose and low-dose ACTH for spasm onset and the high rate of disappearance of EEG (P> 0.05). The high dose of ACTH has more side effects than the low dose of ACTH. TL is the effect of short-term ACTH Independent risk factors.