摘要
目的评估按需和按时服用生酮饮食（ketogenicdiet，KD）两种方案的疗效和安全性。方法采用随机数字表法将60例难治性癫痫患儿随机分成按需服用KD组和按时服用KD组，每组30例。全量服用KD后连续72h每6小时监测血酮、血糖和尿酮，比较两组患JLN症状态的稳定性。记录发作频率并确定起效时间，分别在治疗后4周、12周、24周、48周评估两组患儿的疗效及安全性。结果治疗4周后，按需服用KD组与按时服用KD组发作完全缓解率分别为33．3％（10／30）与30．0％（9／30），两组疗效相当（P〉0．05）。按需服用KD组治疗有效病例平均起效时间为（6．18±2．42）d，而按时服用KD组有效病例平均起效时间为（8．63±2．63）d，两组比较差异有统计学意义（P〈0．05）。治疗后12周、24周和48周，按需服用KD组发作完全缓解率分别为30．0％（9／30）、34．8％（8／23）和36．8％（7／19）；按时服用KD组发作完全缓解率分别为33．3％（10／30）、30．4％（7／23）和44．4％（8／18），两组比较差异无统计学意义（P〉0．05）。1年后，按需服用KD组和按时服用KD组治疗保留率分别为63．3％（19／30）与60．0％（18／30），两组比较差异无统计学意义（P〉0．05）。治疗过程中，按需服用KD组与按时服用KD组的不良反应主要为可治疗的胃肠道反应和代谢紊乱。结论按需服用KD和按时服用KD两种治疗方案均基本安全有效，按需服用方案更易达到酮症状态，起效更迅速，较易被患儿接受。因此在临床实施过程中可根据患儿的饮食习惯，灵活安排进食时间以提高治疗的依从性。
Objective To assess the efficacy and safety of two different protocols of ketogenic diet （KD） -eating on demand or eating at regular intervals for refractory epilepsy in children. Methods Sixty children with refractory epilepsy were randomly divided into eating on demand group （ n = 30） and eating at regular intervals group （n = 30） by random number table method. After taking the whole amount of KD, the capillary blood ketone and glucose level and urine ketone were monitored every 6 hours in 72 continuous hours. Seizure frequency and onset time were recorded. Antiepileptic efficacy and diet tolerability of the two groups were evaluated on 4 weeks, 12 weeks,24 weeks and 48 weeks after initiating the diet. Adverse effects were monitored. Results After treatment of 4 weeks,the complete seizure remission rates of eating on demand group and eating at regular intervals group were 33.3% （10/30） and 30. 0% （9/30） respectively ,which suggested a com- parable efficacy for two groups （P 〉0. 05）. The day when KD started to work was averaged （6. 18 ±2. 42） d and （ 8. 63 ± 2. 63 ） d respectively. The group of eating on demand showed a faster onset of action （ P 〈 0. 05 ）. After treatment of 12 weeks, 24 weeks and 48 weeks, complete seizure remission rates of eating on demand group were 30. 0% （9/30） ,34. 8 % （8/23） and 36. 8 % （7/19 ） respectively;the eating at regular intervals group were 33.3% （ 10/30）, 30.4% （ 7/23 ） and 44.4% （ 8/18 ） respectively. The two groups had no significant difference （P 〉 0. 05 ）. One year later, the treatment retention rates of the two groups were 63.3 % （19/30） and 60. 0% （18/30） respectively. There was no significant difference （P 〉0. 05）. The adverse effects mainly inclu- ding transient gastrointestinal symptoms and metabolic disturbances were mostly tolerable and curable. Conclusion The two different protocols of KD-eating on demand and eating at regular intervals are both effective and well-tolerated for refractory epilepsy in children. While protocol of eating on demand is more easier to achieve ketotic state and the effect is more quickly, so it can be more easily received by children. Therefore in clinical practice ,we can choose flexible eating time according to children＇s eating habits ,which can improve the therapeutic compliance.
出处
《中国小儿急救医学》
CAS
2012年第5期473-476,共4页
Chinese Pediatric Emergency Medicine
基金
基金项目：深圳市科技计划项目（200903105）
关键词
生酮饮食
难治性癫痫
儿童
Ketogenic diet
Refractory epilepsy
Children
