婴儿痉挛促肾上腺皮质激素治疗疗效影响因素研究

Evaluate the efficacy and impact of prognostic factors about ACTH treatment of infantile spasms

目的对促肾上腺皮质激素(ACTH)治疗的婴儿痉挛(IS)患儿进行临床表现、脑电图、影像学等多因素分析,评价影响疗效及预后的因素。方法对2007年7月至2009年7月经ACTH治疗的30例IS患儿的临床资料及治疗后半年至2年随访结果,对预后的评估进行回顾性研究。结果 30例IS患儿中72%为症状性,隐源性IS经ACTH治疗有效病例,经正规后续治疗,71.4%病例无抽搐发作,预后较好。ACTH总有效率86%(26/30);ACTH疗效及预后与患儿起病年龄、治疗前痉挛持续时间、头颅影像学的关系不明显;与痉挛发作类型有关。发病年龄低于3个月者,抽搐发作较易控制,但智力运动预后差;脑电图治疗前后变化对预后判断有帮助。结论 ACTH对脑皮层细胞高度失律放电有非选择性的抑制作用;ACTH近期疗效与治疗前痉挛发作持续时间无关;对称性屈曲型痉挛发作预后较非对称性发作预后好;治疗前脑电图呈对称性背景节律的隐源性者预后较好。

Objective To evaluate the efficacy and impact of prognostic factors about Adrenocorticotropic hormone （ACTH） treatment of infantile spasms （IS） in children with clinical manifestations, EEG, imaging and many other factors. Methods Collecting IS 30 cases of ACTH treatment clinical data and treatment of children from Bayi Children＇ s Hospital ward neural development in July 2007 to 2009 period, six months to 2 years after follow-up results, and prognosis were studied retrospectively. Results 30 patients with IS, 72% of children with symptomatic, crypto- genic IS cases by ACTH treatment is effective, regular follow-up after treatment, 71.4% of the cases bad no seizure, the better the prognosis. ACTH total effective rate of 86 % （26/30）. ACTH efficacy and prognosis of children with onset age, duration of spasms before treatment, no significant relationship between the imaging head ; the type and seizure onset. Age of onset less than 3 months after the seizure, more easy to control, but the intellectual exercise and poor prognosis. EEG changes before and after treatment the prognosis helpful. Conclusion ACTH on the cortical cells have a high degree of loss of legal non-selective inhibition of discharge. ACTH term efficacy and duration of treatment independent of seizure onset, symmetry of flexion-type seizure onset prognosis than non-symmetrical seizure prognosis good. cryptogenic treatment EEG background rhythm was symmetrical better prognosis.