儿童难治性癫痫采用生酮饮食治疗对血脂水平影响的研究分析

Effect of Ketogenic Diet on Serum Lipid Levels in Children with Refractory Epilepsy

目的评估经典生酮饮食(ketogenic diet,KD)治疗儿童难治性癫痫过程中对血脂水平的影响。方法回顾性收集2016年1月~2020年6月在西安市儿童医院神经内科接受KD添加治疗的药物难治性癫痫患儿54例,其中男性39例(72.2%),女性15例(27.8%)。所有纳入病例均至少接受KD治疗三个月,且不管终止KD治疗的时间点,比较KD治疗前、KD治疗1,3,6,12个月末血清中总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)及三酰甘油(TG)水平变化,进行相应统计学分析,P<0.05为差异具有统计学意义。结果54例接受KD治疗的药物难治性癫痫患儿被纳入研究,采用单因素重复测量方差分析及Bonferroni检验两两比较发现,血清TC,TG,LDL平均水平在KD治疗1,3,6个月末均明显升高,差异有统计学意义(F=14.655,10.980,20.292,均P<0.001),在KD治疗三月后出现高脂血症的患儿比例最高,此后该比例逐渐下降。根据接受KD治疗时长,将患儿分为三组:3~6个月(第1组,n=23),6~12月(第2组,n=22)和>12月(第3组,n=9),采用单因素方差分析及Games-Howell检验两两比较发现,在接受KD治疗6个月末,第1组病例患儿的LDL平均水平低于第2组和第3组病例患儿,差异有统计学意义(F=3.532,P=0.037),而第2组和第3组病例患儿的LDL平均水平比较差异无统计学意义(P>0.05)。此外,不同分组的病例患儿TC,TG及HDL平均水平比较差异均无统计学意义(P>0.05)。结论经典高脂肪比例KD治疗可导致患儿TC,TG和LDL水平明显升高,且在治疗三个月后出现血脂异常患儿比例最高,但大部分在停止KD治疗或饮食干预后可逐渐恢复正常。

Objective To evaluate the effect of ketogenic diet(KD)on serum lipid levels in children with refractory epilepsy.Methods This retrospective study enrolled 54 patients,including 39 males(72.2%)and 15 females(27.8%),with drug resistant epilepsy treated with KD at Deparment of Neurology,Xi’an Children’s Hospital,between January 2016 and June 2020.All included patients received KD treatment for at least 3 months,regardless of the time point of termination of KD treatment,at baseline and post-treatment 1,3,6,and 12 months,total cholesterol(TC),high-density lipoprotein(HDL),low-density lipoprotein(LDL)and triglyceride(TG)levels were measured and compared,P<0.05 were considered to be statistically significant.Results 54 children with drugresistant epilepsy receiving KD were included in the study,using Mean total TC,TG and LDL levels were significantly higher at 1st,3rd and 6th months of the KD treatment compared to baseline levels(F=14.655,20.292,10.980,P<0.001),using univariate repeated measures analysis of variance and Bonferroni test,the differences were statistically significant.The ratio of the patients who developed dyslipidemia was highest at 3rd month of the KD treatment,and decreased after that.Patients were divided in three groups based on duration between KD initiation and discontinuation:3~6 months(group 1,n=23),6~12 months(group 2,n=22)and>12 months(group 3,n=9).One-way ANOVA was performed to analyse the lipid differences among the three above groups.To identify the source of significant differences among means,post hoc analysis was performed using the Games-Howell test.The mean LDL levels of patients in the group 1 were lower at 6th months post KD,compared to those were in the group 2 and group 3,the difference was statistically significant(F=3.532,P=0.037),but no significant difference of mean LDL levels was found between the groups 2 and 3.In addition,the mean levels of TC,TG and HDL among the three groups were not significant different(P>0.05).Conclusion Classical high-fat ratio KD treatment can lead to significant increase of TC,TG and LDL levels in patients.The proportion of patients with dyslipidemia was the highest at three months of the KD treatment,but most of them gradually recovered after discontinuation of KD treatment or interventions.