泼尼松治疗婴儿痉挛症有效性及HPA轴机制分析

The efficacy of prednisone in the treatment of infantile spasm and HPA axis mechanism analysis

目的 通过研究泼尼松治疗前后婴儿痉挛症(infantile spasm,IS)的发作、脑电图的改变及下丘脑-垂体-肾上腺(hypothalamus-pituitary-adrenal,HPA)轴功能的改变,探讨泼尼松治疗婴儿痉挛症的有效性、HPA轴在IS发病机制中的作用,阐明泼尼松控制痉挛发作的HPA轴相关机制.方法 共收集30例符合标准IS病例(IS组),与30例健康婴幼儿(对照组)对比,对30例IS病例在泼尼松治疗前后进行发作次数记录、EEG监测、HPA轴功能检测,采用化学发光法检测血清皮质醇、促肾上腺皮质激素(adreno-cortico-tropic-hormone,ACTH)水平;利用酶联免疫吸附法检测血清促肾上腺皮质激素释放激素(corticotro-phin Releasing hormone,CRH)水平.结果 用药前IS组血清CRH水平均较正常对照组高,且差异有统计学意义(P<0.05),而IS组血皮质醇、ACTH与正常对照组比较无明显差别,差异无统计学意义(P>0.05);平均每日发作串数、平均每日发作总次数分别与CRH呈正相关(P<0.05);应用泼尼松后,经泼尼松治疗后30例IS病例有19例发作控制,11例发作未控制,有18例脑电高度失律完全缓解,12例脑电高度失律未完全缓解,治疗后每日发作串数及每日发作总次数均较治疗前明显下降,差异有统计学意义(P<0.05),治疗后的DQ较治疗前DQ改善,有统计学意义(P<0.05),病程是泼尼松治疗效果的主要影响因素,病程越长,治疗效果越差,差异有统计学意义(P<0.05).治疗后的CRH、皮质醇、ACTH较治疗前明显下降,差异有统计学意义(P<0.05).结论 泼尼松能有效控制婴儿痉挛症的发作,早期治疗效果更好,IS患儿存在HPA轴功能紊乱,泼尼松能调节HPA轴功能紊乱起到控制痉挛发作的效果.

Objective By studying the changes of the seizures of infantile spasm(IS)、EEG and HPA axis function before and after the treatment of prednisone,to explore the efficacy of prednisone in treating infan-tile spasm,the role of HPA axis in the pathogenesis of IS,and elucidate the HPA axis mechanism of prednisone in controling seizure.Methods A total of 30 patients with IS (IS group) and 30 cases of healthy infants and young children (control group) were recruited.Number of seizures、EEG、HPA axis function was detected be-fore and after the treatment of prednisone in patients with infantile spasm.Serum cortisol,ACTH were deter-mined by the chemiluminescence analysis,serum CRH was measured by enzyme-linked immunosorbent assay. Results serum CRH levels of IS group was significantly higher than normal control group(P<0.05).Serum cortisol,ACTH in IS group were no evidently different compared with control group (P>0.05).The average number of daily ictal clusters and the average daily total seizure number positively correlated with CRH respec-tively.After the application of the prednisolone,seizure of 19 cases of the IS were controlled,11 cases were not controlled,18 cases of hyperarrhythmia were completely remited and 12 cases of hyperarrhythmia were not com-pletely remited.The average number of daily ictal clusters and The average daily total seizure number after treat-ment were significantly lower than before treatment(P<0.05);DQ after treatment was higher than DQ before treatment(P<0.05);The pathogenesis was the main influencing factor of the prednisone treatment effect,the length of the disease,the worse the treatment(P<0.05).CRH、cortisol、ACTH after treatment were significantly lower than before treatment(P<0.05).Conclusion Prednisone can effectively control the onset of infantile spasms,and early treatment is better.IS patient has HPA axis dysfunction,and prednisone can regulate HPA axis dysfunction to control spasm.