生酮饮食治疗儿童全面性发育迟缓的前瞻性研究

Prospective study of ketogenic diet in treatment of children with global developmental delay

目的观察生酮饮食(KD)对全面性发育迟缓(GDD)患儿神经行为发育、情绪和社会行为及生活能力的影响。方法采用前瞻性病例对照研究,对住院的GDD患儿随机分为KD治疗组和常规治疗组,最终常规治疗组37例和KD治疗组40例纳入研究。两组患儿均进行综合康复训练,KD治疗组在此基础上给予生酮饮食改良Atkins治疗方案。治疗前及治疗后3、6、9个月对两组患儿进行Gesell发育量表、中国幼儿情绪性及社会性发展量表(CITSEA)/Achenbach儿童行为量表(CBCL)、婴儿-初中学生社会生活能力量表(S-M量表)评估,比较2组之间神经行为发育、情绪和社会行为及生活能力的改善情况。结果治疗后3、6、9个月两组患儿Gesell评分比较,在适应性、精细动作、言语3个能区的评分,KD治疗组改善情况优于常规治疗组(P<0.05);治疗后3、6、9个月两组患儿CITSEA/CBCL评分比较,KD治疗组改善情况亦优于常规治疗组(P<0.05);治疗后9个月KD治疗组S-M量表评分改善情况优于常规治疗组(P<0.05)。KD治疗期间,6例患儿出现腹泻症状,1例出现轻度泌尿系结石。结论 KD治疗可改善GDD患儿的神经行为发育及情绪和社会行为,且不良反应少。

Objective To study the effect of ketogenic diet（KD） on neurobehavioral development, emotional and social behaviors, and life ability in children with global developmental delay（GDD）. Methods A prospective case-control study was performed for hospitalized children with GDD, who were randomly divided into KD treatment group（n=40） and conventional treatment group（n=37）. The children in both groups were given comprehensive rehabilitation training, and those in the KD treatment group were given modified Atkins diet in addition to the comprehensive rehabilitation training. The children in both groups were assessed with the Gesell Developmental Scale, Chinese version of Urban Infant-Toddler Social and Emotional Assessment（CITSEA）/Achenbach Child Behavior Checklist（CBCL）, and Infants-Junior High School Students＇ Social Life Abilities Scale（S-M scale） before treatment and after 3, 6, and 9 months of treatment. The two groups were compared in terms of the improvements in neurobehavioral development, emotional and social behaviors, and social life ability. Results After 3, 6, and 9 months of treatment, the KD treatment group had significantly greater improvements in the scores of the adaptive, fine motor, and language quotients of the Gesell Developmental Scale compared with the conventional treatment group（P0.05）; the KD treatment group had significantly greater improvements in CITSEA/CBCL scores than the conventional treatment group（P0.05）. The KD treatment group had a greater improvement in the score of the S-M scale after 9 months of treatment（P0.05）. During the KD treatment, 6 children experienced diarrhea and 1 experienced mild urinary stones. Conclusions KD can improve the neurobehavioral development and behavioral and emotional behaviors in children with GDD, and it has few adverse effects.