首选多药联合治疗新诊断婴儿痉挛的临床疗效及随访研究

Clinical efficacy and follow-up of initial polytherapy for children with newly diagnosed infantile spasms

目的探讨首选多药联合治疗新诊断婴儿痉挛的疗效、对预后的影响及影响因素。方法 (1)收集自2007年9月～2010年11月本院收治的108例新诊断的婴儿痉挛患儿的病例资料,首选多药联合治疗,并进行追踪随访,对其临床资料回顾性研究。(2)治疗方案:采用ACTH、托吡酯、维生素B6、丙种球蛋白多药联合治疗。结果 (1)108例中90例完全控制,8例有效,10例无效,完全控制率83.3%,总有效率90.7%;(2)随访全部患儿5个月～3年,无1例死亡,痉挛发作完全控制者中复发率为7.8%(7/90);随访其中21例发作完全控制者入院时及痉挛发作完全控制后1个月时Gesell量表测定结果,无统计学意义,完全控制6个月时与治疗前Gesell量表测定结果比较,有统计学意义。结论 (1)多药联合治疗新诊断婴儿痉挛发作具有较高的完全控制率及有效率,症状性婴儿痉挛完全控制所需时间长于隐源性婴儿痉挛。(2)采用多药联合治疗新诊断婴儿痉挛可提高患儿智能,有助于改善预后。

Objective To investigate clinical efficacy and prognosis factors of polytherapy on children with newly diagnosed infantile spasms.Methods 108 cases with newly diagnosed infantile spasms were involved from September 2007 to November 2010 in the Department of Pediatric Neurology,and Rehabilitation of the First Hospital of Jilin University.The data were retrospectively analyzed and the follow-up was carried out in outpatient clinic,and the dynamic psychomotor changes of 21 cases with seizure free were monitored at the time points of admission,1 month and 6 months after spasm free,respectively.Results(1) Of 108 cases in this study,90 patients were seizure free,8 cases were effective,and 10 cases were ineffective,so the complete control rate was 83.3%,and the total effective rate was 90.7%.(2) All patients were followed-up for 5 months to 3 years and no one died during the time.7 cases(7.8%) relapsed.There was no significant difference in 21 cases with seizure free on the intelligence test between the time points of admission and one month since seizure free.Intelligence was significantly improved 6 months since seizure free when compared with admission.Conclusion Effective and seizure rates in infantile spasms cases treated with polytherpy are relatively higher,and the time to seizure free in symptomatic ones is longer than that in the cryptogenic cases.Polytherapy for infantile spasms can ameliorate the abnormal EEGs after seizure cessation.Intelligence is improved 6 months after seizure and the prognosis may be improved with polytherapy in children with infantile spasms.