酮饮食治疗成人难治性癫痫的疗效:RCT研究的系统评价及Meta分析

Efficacy and Compliance of Ketogenic Diets in Adults with Intractable Epilepsy:A Systematic Review and Meta-Analysis of RCT

目的:系统评价生酮饮食(KD)对成人难治性癫痫的疗效和依从性。方法:系统性检索PubMed、Web of Science、Embase和Cochrane图书馆,自建库至2022年2月的RCT文献。由2位研究者独立对文献进行资料提取和质量评价后,使用RevMan软件对纳入文献进行Meta分析。结果:共纳入4项RCT研究,其中3项研究为KD与常规饮食对照,共计纳入221例患者。另外1项研究为不同KD之间比较,纳入80例患者。结果显示,癫痫发作减少≥50%有效率方面,荟萃分析支持KD组,但差异无统计学意义。考虑到异质性,仅纳入Zare(2017)及Kishk(2021)2项研究,有效率为48.65%,差异有统计学意义。失访率荟萃分析显示结果更支持常规饮食,但差异无统计学意义。与单独使用改良阿特金斯饮食(MAD)相比,在第1个月用生酮配方补充MAD,患者失访率低,依从性更好。结论:KD是成人难治性癫痫有希望的补充疗法,耐受性良好。

Objective:To evaluate the efficacy of ketogenic diets(KD)treatment for adults with intractable epilepsy and patients’compliance for KD treatment by systematic review.Methods:PubMed,Web of Science,Embase,and the Cochrane Library were systematically searched for RCT studies in adults published up to February 2022.After data extraction and quality evaluation of the studies independently by two researchers,meta-analysis was performed on the included studies using RevMan software.Results:A total of 4 RCTs were included,3 of which evaluated KD versus conventional diet,with a total of 221 cases.Another study compared different KD and included 80 cases.The results showed that the meta-analysis supported the KD group,in terms of the effective rate of 50%or more reduction in seizure frequency,but the difference was not statistically significant.Considering the heterogeneity,only two studies(Zare 2017 and Kishk 2021)were included,and the effective rate was 48.65%,with the difference being statistically significant.The loss-to-follow meta-analysis showed that the results were more supportive of a regular diet,but the difference was not statistically significant.Supplementation of the Modified Atkins Diet(MAD)in the first month with a ketogenic formula resulted in lower loss to follow-up and better compliance than MAD alone.Conclusion:KD is a promising complementary therapy for adults with intractable epilepsy and is well tolerated.