促肾上腺皮质激素治疗婴儿痉挛症疗效相关因素分析

Related Factors Analysis of Therapeutic Effect of Adrenocorticotropic Hormone in Treatment of Infantile Spasms

目的:研究促肾上腺皮质激素(ACTH)治疗婴儿痉挛症(IS)疗效的相关因素。方法:2019年10月-2021年5月安徽省儿童医院神经内科收治IS患儿68例,根据ACTH治疗后疗效分为完全缓解组(n=41)、有效组(n=9)、无效组(n=18)。分析三组患儿入院时的临床资料及脑电图结果。结果:ACTH治疗IS的总有效率为73.53%。三组患儿病程、治疗前发育情况、脑电图是否典型高度失律、放电侧别(偏侧/双侧)比较,差异有统计学意义(分别为χ^(2)=12.396,P=0.002;χ^(2)=7.252,P=0.023;χ^(2)=25.327,P=0.000;χ^(2)=22.350,P=0.000);三组患儿性别、发病年龄、ACTH是否首选、出生史有无异常、脑电图背景、纺锤波、放电部位(限局/广泛)比较,差异无统计学意义(P>0.05)。Logistic回归分析显示,完全缓解组与无效组病程、脑电图是否典型高度失律、放电侧别有显著相关性(分别为b=2.926,P=0.018;b=2.148,P=0.032;b=-3.069,P=0.009)。结论:病程短、脑电图表现为典型高度失律、双侧放电的IS患儿经ACTH治疗的疗效好。

Objective:To study the related factors of the curative effect of adrenocorticotropic hormone(ACTH)in the treatment of infantile spasm(IS).Methods:From October 2019 to May 2021,68 children with IS were selected from the Department of Neurology,Children's Hospital of Anhui Medical University,they were divided into the complete remission group(n=41),the effective group(n=9),and the ineffective group(n=18)according to the curative effect of ACTH treatment.The clinical data and EEG results of the three groups of children at admission were analyzed.Results:The total effective rate of ACTH in the treatment of IS was 73.53%.There were statistically significant differences in the course of disease,development status before treatment,whether the EEG showed typical high arrhythmia,and the side of discharge(lateral/bilateral)among the three groups of children(χ^(2)=12.396,P=0.002;χ^(2)=7.252,P=0.023;χ^(2)=25.327,P=0.000;χ^(2)=22.350,P=0.000).There were no statistically significant differences among the three groups of children in gender,age of onset,whether ACTH was preferred,whether there was any abnormality in the birth history,EEG background,spindle wave,and discharge location(limited/extensive)(P>0.05).Logistic regression analysis showed that there was a significant correlation between the course of disease,whether the EEG showed typical high arrhythmia,and the side of discharge in the complete remission group and the ineffective group(b=2.926,P=0.018;b=2.148;P=0.032;b=-3.069,P=0.009).Conclusion:The curative effect of ACTH is good in IS children with short course of disease,typical high arrhythmia in EEG,and bilateral discharge.