大剂量甲泼尼龙冲击治疗婴儿痉挛症的临床分析

High-dose methylprednisolone effect on infantile spasms

目的 探讨大剂量甲泼尼龙冲击治疗对婴儿痉挛的控制效果.方法 对郑州大学第三附属医院2002年11月至2012年11月收治的66例婴儿痉挛症采用静脉冲击甲泼尼龙20 mg/（kg.d）连续应用3～5 d,后改为口服强的松片1 ～2 mg/（kg·d）,4～8周后减量停药,总疗程8～12周,对治疗的临床疗效进行回顾性研究.结果 （1）66例患儿中治疗有效者51例,总有效率77.2％,28例完全缓解,完全缓解率42.4％.（2）起病年龄对疗效无影响（P＞0.05）.（3）开始用甲泼尼龙治疗的年龄对疗效无影响（P＞0.05）.（4）病程对疗效的影响：病程在2个月以内者23例,有效率91.3％;大于2个月者43例,有效率69.7％,两组比较差异有统计学意义（x2=3.958,P＜0.05）.（5）病因对疗效的影响：症状性50例,有效率78.o％;隐源性16例,有效率75.0％;二组比较差异无统计学意义（x2 =0.008 7,P ＞0.05）.（6）远期随访41例患儿,完全缓解14例（34.2％）,有效29例（70.7％）,复发3例（复发率10.3％）.结论 应用甲泼尼龙治疗婴儿痉挛症的方案简单易行,近期控制效果肯定,不良反应少而轻;疗效与病程相关,病程越短,疗效越好;远期疗效可,复发率低,可以在临床上推荐应用.

Objective To discuss high dose methylprednisolone therapy in infantile spasm. Methods Sixty-six children with infantile spasm of the Third Affiliated Hospital of Zhengzhou University from Nov 2002 to Nov 2012, adopted intravenous methylprednisolone with 20 mg/（kg-d） for 3 to 5 days continuously, then changed to oral prednisone with 1 -2 mg/（kg.d） ,4 - 8 weeks after drug withdrawal. The total course of 8 - 12 weeks of clinical curative effect was retrospectively studied. Results （ 1 ） Of 66 cases,51 cases were effective,total effective rate was 77. 2% ;28 cases achieved complete response, complete response rate was 42.4%. （2） The onset age had no influence on curative effect （P 〉0. 05）. （3） The beginning ages of the patients to use methylprednisolone therapy had no effect on curative effect （ P 〉 0.05 ）. （4） Course of cura- tive effect：23 cases within 2 months,the effective rate was 91.3% ,43 cases more than 2 months,the effec- tive rate was 69.7%. Difference of effective rate between the two groups had statistical significance （ x2 = 3. 958,P 〈0. 05）. （5） Etiology of curative effect：50 cases of symptomatic,the effective rate was 78.0% ,16 cases of cryptogenic, the effective rate was 75.0% ;compared two groups, the effective rates had no statistical significance（ X2 = 0. 008 7 ,P 〉 0. 05 ）. （6） Long-term follow-up of 41 cases, 14 cases had complete remis- sion （34. 2% ） ,29 cases was effective（70. 7% ） ,3 cases had a recurrence （10. 3% ）. Conclusion Applica- tion of methylprednisolone in the treatment for infantile spasm is simple,the recent control is effective,and it has a less adverse effect. The curative effect is related to the course, the shorter the duration, the better cura- tive effect;and the long-term effect is good, the recurrence rate is low, the method can be recommended in clinical application.