生酮饮食疗法联合醋酸艾司利卡西平治疗药物难治性癫痫的效果观察

Therapeutic effect of ketogenic diet therapy combined with eslicarbazepine acetate on patients with drug refractory epilepsy

目的探讨生酮饮食疗法对药物难治性癫痫患者癫痫发作情况、免疫功能及神经递质水平的影响。方法选取2019年12月—2020年12月河南省某医院收治的89例药物难治性癫痫患者为研究对象。采用随机数字表法,将患者分为观察组(n=45)与对照组(n=44)。对照组患者采用醋酸艾司利卡西平进行治疗。观察组在对照组基础上增加生酮饮食治疗。比较2组患者治疗效果。比较2组患者治疗前1天、治疗6个月时T淋巴细胞总值(CD3+)和T淋巴细胞亚群(CD4+、CD8+)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)水平。比较2组患者治疗前1天、治疗6个月时去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)水平。比较2组患者治疗期间的不良反应发生情况。结果观察组患者治疗有效率为66.67%,高于对照组的45.45%,差异有统计学意义(P<0.05)。治疗6个月时,2组患者IgA、IgG及IgM水平均低于治疗前1天,且观察组低于对照组,差异均有统计学意义(P<0.05)。治疗6个月时,2组患者CD3+、CD4+水平均高于治疗前1天,且观察组高于对照组,差异有统计学意义(P<0.05)。治疗6个月时,2组患者CD8+水平均低于治疗前1天,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗6个月时,观察组患者NE、DA、5-HT水平均高于治疗前1天,且观察组高于对照组,差异均有统计学意义(P<0.05)。2组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论生酮饮食疗法联合醋酸艾司利卡西平对药物难治性癫痫具有显著的干预效果,可以通过改善患者神经递质水平,有效控制癫痫发作及减少对免疫功能的损坏,且具有较高的安全性,临床可以推广使用。

Objective To investigate the effects of ketogenic diet therapy on status epilepticus,immune function and neurotransmitter levels in patients with drug refractory epilepsy.Methods A total of 89 patients with drug refractory epilepsy treated in a hospital in Henan Province from December 2019 to December 2020 were selected as the objects.The patients were randomly divided into observation group(n=45)and control group(n=44).The patients in the control group were treated with eslicarbazepine acetate.The observation group was treated with ketogenic diet on the basis of the control group.The therapeutic effects of the two groups were compared.The levels of leukocyte differentiation antigen 3(CD3+),leukocyte differentiation antigen 8(CD8+),leukocyte differentiation antigen 4(CD4+),immunoglobulin A(IgA),immunoglobulin M(IgM)and immunoglobulin G(IgG)were compared between the two groups 1 day before treatment and 6 months after treatment.The levels of norepinephrine(NE),dopamine(DA)and 5-hydroxytryptamine(5-HT)were compared between the two groups 1 day before treatment and 6 months after treatment.The adverse reactions were compared between the two groups during treatment.Results The effective rate of patients in the observation group was 66.67%,which was higher than that in the control group(45.45%),and the difference was statistically significant(P<0.05).At 6 months after treatment,the levels of IgA,IgG and IgM in the two groups were lower than those in the first day before treatment,those in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).At 6 months after treatment,the levels of CD3+and CD4+in the two groups were higher than those in the first day before treatment,those in the observation group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).At 6 months after treatment,the level of CD8+in the two groups was lower than that in the first day before treatment,the level in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).At 6 months after treatment,the levels of NE,DA and 5-HT in the observation group were higher than those in the first day before treatment,the levels in the observation group were significantly higher than those in the control group,the difference was statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Ketogenic diet therapy combined with eslicarbazepine acetate has a significant intervention effect on drug refractory epilepsy.It can effectively control seizures and reduce the damage to immune function by improving the level of neurotransmitters in patients with drug refractory epilepsy.It has high safety and can be widely used in clinic.