应用计算机软件提高经典及非经典生酮饮食治疗难治性癫痫的操作性

A calculator for the classic and non-classic ketogenic diet based on Chinese food composition therapy on refrac- tory epilepsy

目的通过计算机辅助设计食谱简化生酮饮食的操作。方法设计一款基于中国食物成分数据库的软件，使用3个模块分别计算经典生酮饮食、改良阿特金斯饮食、低血糖生成指数饮食，用于指导药物无效且无法手术的10例难治性癫痫患者添加经典及非经典生酮饮食。其中儿童患者8例，成人患者2例，年龄1—34岁。每日均有发作患者8例，其余2例每月发作4～15次。患者平均用药2．7种，患者均随访0．5年以上。该软件在输入患者年龄、身高、体质量、活动量、脂肪比例资料后，能自动显示患者每日所需能量及3大营养素摄人推荐值，然后选择不同模块进行自动配餐。2例患者使用经典4：1生酮饮食模块；4例一开始使用经典4-1生酮饮食模块，2～5个月后转为1：1～4：1改良阿特金斯饮食模块；4例患者使用1：1—4：1改良阿特金斯饮食模块。结果40％（4／10例）的患者减少发作50％～90％，20％（2／10例）的患者减少发作90％～99％，20％（2／10例）的患者无发作。随访0．5年的保留率为70％（7／10例）。结论该软件对简化操作、提高保留率有重要作用，可作为核心技术在难治性癫痫患儿的经典生酮饮食疗法及非经典生酮饮食疗法中使用。

Objective To simplify the manipulation of ketogenic diet recipes through software design. Metho- ds Based on a Chinese food composition database, the software included 3 separate modules for the calculation of reci- pes for the classic ketogenic diet,modified Atkins diet and low glycemic index diet. It was applied in l0 refractory epi- lepsy patients,including 8 children and 2 adults, aged from 1 to 34 years,who took an average of 2.7 kinds of medica- tion. Eight patients had daily seizures ;the other 2 cases had seizures 4 - 15 times per month. Two patients used the clas- sic 4： 1 ketogenic diet module;4 patients started with the classic 4 ： 1 ketogenic diet and then shifted to 1 ： 1 to 4 ： 1 modified Atkins diet module after 2 to 5 months;4 patients used the 1 ： 1 to 4 ： 1 modified Atkins diet module. The software could automatically display the daily recommended intake value of total energy, fat, carbohydrate and protein according to the input of age, height, weight, activity level and the proportion of fat/（ carbohydrate and protein ）, then patients or dietitians were allowed to select a different modules for recipe design. Results Forty percents（4/10 cases） of the patients had seizure reduced to 50% -90% ,20% （2/10 cases） of the patients had seizure reduced to 90% - 99% , and 20% （2/10 cases） of the patients became seizure free. Half-year retention rate reached 70% （7/10 cases）. Conclusions This specially designed software for Chinese epilepsy patients can help simplify the operation of the keto- genic diet and modified Atkins diet and improve retention rates. It can be used in classic and non-classical ketogenic di- ets.