生酮饮食治疗急性脊髓损伤的安全性和可行性

A clinical trial of ketogenic diet in patients with acute spinal cord injury: safety and feasibility

目的测量接受生酮饮食(KD)治疗的急性脊髓损伤患者的血酮和血糖水平,评价KD治疗的安全性和可行性。方法收录2012年5月~2013年10月被诊断为急性脊髓损伤的患者共10例,予以KD治疗,每日监测血酮、血糖、尿酮。每周观察监测血常规、电解质、肝肾功、体质量指数等各项指标及不良反应,评价其临床安全性及可行性。结果 10例患者分别接受KD治疗4~29 d,平均12.9 d。所有患者血酮于禁食期内升高并在进食KD后维持于2.0 mmol/L以上,尿酮保持于+++^++++,血糖保持于2.2 mmol/L以上。除血清氯及体质量指数外,血常规、电解质、肝肾功各项指标治疗前后无显著性差异。轻触觉及针刺觉未见明显改变,运动ASIA总评分从平均33.3分增加到35.1分。5例患者出现不同程度的肠道功能紊乱(腹泻,恶心,食欲不佳,腹部不适感),1例患者于初期出现低血糖症状,1例患者维持期出现荨麻疹。所有不良反应在给予对症处理后均得到改善。结论 KD能够提高急性脊髓损伤患者酮体水平、维持血糖正常水平。研究结果不仅表明对急性脊髓损伤患者行生酮饮食是安全和可行的,也为今后研究其临床疗效奠定了基础。

Objective To conduct a clinical trial of ketogenic diet （KD） in patients with acute spinal cord injury （SCI） and evaluate its safety and feasibility by measuring blood ketone bodies and blood glucose levels. Method Ten patients with acute SCI were recruited in the trial during the period from May 2012 to October, 2013. The patients received a standard KD after fasting for 48 h. The levels of blood ketone, blood glucose and uric ketone were tested daily, and routine blood examination, electrolytes, liver and kidney function, body mass index （BMI）, sensory and motor function, and adverse reactions were monitored weekly to assess the safety and feasibility of KD. Results KD treatment lasted for a mean of 12.9 days （4 to 29 days） in these patients. In all the patients, blood ketone level increased during the fasting and maintained a level above 2.0 mmol/L after taking KD, while the uric ketone level ranged from ＋＋＋ to ＋＋＋＋. The blood glucose level was in the normal range during KD. Except for blood chloride level and BMI, routine blood test results, electrolytes, liver and kidney function showed no significant changes after KD. No significant changes were observed in the sensation of light touch and pinprick. The average motor ASIA score increased from 33.3 to 35.1 after KD. Gastrointestinal dysfunction （diarrhea, nausea, poor appetite, gastric pain, and abdominal distension） was recorded in 5 patients, hypoglycemia occurred in one patient early after KD, and one patient experienced urticaria during KD. All the adverse reactions were relieved after symptomatic treatments. Conclusion This preliminary clinical trial demonstrated that KD could increase ketone bodies level and maintain a normal blood glucose level, suggesting its safety and feasibility in patients with acute SCI.