促肾上腺皮质激素治疗36例婴儿痉挛症的疗效分析

Effects of adrenocorticotrophic hormone in 36 cases of infantile spasms

目的分析促肾上腺皮质激素（adrenocorticotrop hichormone，ACTH）治疗婴儿痉挛症的疗效。方法收集我院2009年1月至2012年10月36例婴儿痉挛症患儿的临床资料，分析其ACTH治疗前后发作缓解率、脑电图改变及智力发育的改善情况。结果（1）治疗结束后5d、3个月、6个月的临床完全缓解率分别为86．1％（31／36）、77．8％（28／36）、50．0％（18／36）；有效率分别为11．1％（4／36）、13．9％（5／36）、36．1％（13／36）；无效率分别为2．8％（1／36）、8．3％（3／36）、13．9％（5／36）。脑电图完全缓解率分别为75．0％（27／36）、58．3％（21／36）、44．4％（16／36）。（2）治疗后3个月、6个月分别与治疗前比较，各能区功能、智龄及发育商均有不同程度的提高（P〈0．001）；治疗后6个月与治疗后3个月比较各能区功能、智龄及发育商均有提高（P〈0．001）。尤其在大动作及适应行为、社交行为方面进步显著。结论确诊婴儿痉挛症后及时应用ACTH治疗，对控制痉挛发作、短期内提高智力发育及改善脑电图具有积极的作用。

Objective To analyze the effects of adrenocorticotrophic hormone （ACTH） in the treatment of infantile spasms （IS）. Methods Clinical data of 36 IS cases in our hospital from January 2009 to October 2012 were collected. Differences in seizure remission rate, EEG changes, and intelligence development before and after ACTH treatment were compared. Results （ 1 ） On the fifth day, the third month, and the sixth month after treatment, the clinical complete remission rates were 86. 1% （31/36） ,77. 8% （28/36）, and 50. 0% （18/36） respectively; the effective rates were 1.1% （4/36）, 13.9% （5/36）, and 36. 1% （13/36） respectively; ineffective rate were 2. 8 % （ 1/36 ）, 8. 3 % （ 3/36 ）, and 13.9 % （ 5/36 ） respectively; EEG complete remission rates were 75. 0% （27/36） ,58. 3% （21/36） ,44. 4% （16/36） respectively. （2） The mental age and all aspects of developmental quotient had significant improvement on the third month and sixth month after treatment compared to the fore-mentioned indexes before treatment （P 〈 0. 001 ）. The mental age and all aspects of developmental quotient on the sixth month after treatment were significantly improved than the indexes on the third month after treatment （P 〈 0. 001 ）, especially in the big action, adaptive behavior, and social behavior. Conclusion ACTH treatment will be helpful to control seizures,increase mental development in the short-term and improve EEG in IS patients.