促皮质素对婴儿痉挛症脑电图改变的影响

Effect of Electroencephalogram Changes in Infantile Spasms Treated with Adrenocorticotropic Hormone

目的探讨促皮质素(ACTH)治疗婴儿痉挛症(IS)前后脑电图的改变趋势,为病因学和治疗学研究提供依据。方法回顾性分析本院小儿神经科收治的44例经ACTH治疗的IS患儿临床资料、治疗前1、2 d及正规治疗14 d后的视频脑电图,对经ACTH治疗前后IS患儿脑电图的放电总数变化情况进行评估,并对其前额额区、中央顶区、枕区、中后颞区4个部位治疗后改善程度是否存在差异及哪个部位改善最明显进行研究。结果 ACTH治疗前后IS患儿脑电图的放电总数变化有统计学意义(Z=-5.217,P<0.05);前额额区、中央顶区、枕区、中后颞区4个部位治疗后较治疗前有改善(M=34.075,P<0.05);上述4个部位用SNK法分别进行两两比较,前额额区与其他部位比较差异均有统计学意义,中央顶区、枕区,中后颞区组两两比较差异均无统计学意义,前额额区的用药前后差值最小。结论 ACTH可明显改善IS的异常放电,其改善程度在各部位之间有差异,其中前额、额区较中央顶区、枕区、中后颞区差,可能与IS的病因和发病机制相关。

Objective To explore the trend of electroencephalogram （EEG） changes in infantile spasms treated with adrenocorticotropic hormone （ACTH） , and to provide reference for further studies into the etiology and treatment of infantile spasms. Methods A retrospective study was conducted in 44 cases with infantile spasms who were treated with ACTH at West China Second University Hospital of Sichuan Uni- versity. The EEG findings were compared obtained 1 -2 days before treatment, EEG findings obtained 14 days after regular treatment, and the changes in the frequency of EEG discharge before and after treatment. The differences in the EEG improvement were analyzed in the pre - frontal region, central - parietal region, occipital region, and posterior medial temporal region and identified which region was most obviously improved. Paired rank sum test was used to compare the frequency of EEG discharge before and after the ACTH treatment and the improve- ment in the 4 regions. SNK test was used to identify which region was most obviously improved. Results Comparison of the changes in the fre- quency of EEG discharge before and after the ACTH treatment showed improvement of EEG （ Z = - 5. 217, P 〈 0.05 ）. The EEG improve- ments in the 4 regions after the treatment were significantly different （ M = 34. 075, P 〈 0.05 ）. The change in the pre - frontal region was sig- nificantly smaller than the other 3 regions. There were no significant differences between central - parietal region, occipital region, and poste- rior medial temporal region. Conclusions ACTH can significantly improve EEG in infantile spasms. The improvements in the 4 regions after the treatment were significantly different, with the pre - frontal region demonstrating smaller change than the central - parietal, occipital, and posterior medial temporal regions. The differences may be associated with the etiology and pathogenesis of infantile spasms.