短程ACTH冲击序贯泼尼松治疗婴儿痉挛症的疗效及对脑电图的影响

Efficacy of short-term ACTH pulse sequential prednisone in the treatment of infantile spasms and its influence on electroencephalogram

目的 探讨短程促肾上腺皮质激素(ACTH)冲击序贯泼尼松治疗婴儿痉挛症(IS)的临床疗效及对脑电图(EEG)的影响。方法选取徐州市儿童医院收治的婴儿痉挛症患儿82例,按照随机数字表法分为对照组与观察组,每组41例。观察组采用ACTH冲击治疗序贯泼尼松片口服,对照组则给予泼尼松片口服。比较两组临床疗效、EEG改善效果和不良反应,比较两组治疗前后痉挛发作频次和中文版Griffiths发育评估量表(GDS-C)评分,随访1年统计复发情况。结果治疗1、2w时,观察组的痉挛控制总有效率显著高于对照组(P<0.05),但治疗3个月后总有效率比较差异无统计学意义(P>0.05);治疗3个月后,观察组的痉挛完全控制率及EEG完全控制率均显著高于对照组,且痉挛缓解时间显著短于对照组(P<0.05)。治疗后,观察组的痉挛发作频率显著低于对照组,PDI和MDI评分显著高于对照组(P<0.05)。观察组复发率为17.24%,显著低于对照组的36.36%,且观察组的复发时间显著长于对照组(P<0.05);两组不良反应比较,差异无统计学意义(P>0.05)。结论短程ACTH冲击序贯泼尼松治疗IS可提高临床疗效及EEG改善效果,改善运动发育及智力水平,降低复发风险,且不明显增加药物不良反应。

Objective To investigate the clinical effect of short-term adrenocorticotropic hormone(ACTH)pulse sequential prednisone in the treatment of infantile spasm(IS) and its influence on electroencephalogram(EEG).Methods A total of 82 children with infantile spasms admitted to Xuzhou Children’s Hospital were selected and divided into control group and observation group according to a random number table,with 41 cases in each group.The observation group was treated with ACTH followed by oral prednisone tablets,while the control group was given prednisone tablets orally.The clinical efficacy,EEG improvement effect and adverse reactions were compared between the two groups.The frequency of seizures and score of Griffiths mental development scales-Chinese(GDS-C) before and after treatment were compared between the two groups.The recurrence was counted after 1 year of followup.Results After 1 and 2 weeks of treatment,the total effective rate of spasm control in the observation group was significantly higher than that of the control group(P<0.05),but there was no significant difference in the total effective rate after 3 months of treatment(P>0.05);After 3 months of treatment,the complete control rate of spasticity and EEG of the observation group were significantly higher than those of the control group,and the relief time of spasticity was significantly shorter tha that of the control group(P<0.05).After treatment,the frequency of seizures in the observation group was significantly lower than that of the control group,and the GDS-C score wassignificantly higher than those of the control group(P<0.05).The recurrence rate of the observation group was 17.24%,which was significantly lower than 36.36% of the control group,and the recurrence time of the observation group was significantly longer than that of the control group(P<0.05);the difference between the two groups of adverse reactions was not statistically significant(P>0.05).Conclusion Short-term ACTH shock sequential prednisone treatment of IS can improve the clinical efficacy and EEG improvement effect,improve motor development and intelligence,reduce the risk of recurrence,and does not significantly increase the side effects of the drug.