| 摘要: |
| 目的:比较不同剂量促肾上腺皮质激素(ACTH)治疗婴儿痉挛(IS)的疗效及不良反应,为临床提供参考。方法:收集2012年1月至2015年12月在我院住院接受ACTH治疗的60例IS患儿的临床资料,采用随机数表法分为小剂量组和大剂量组各30例。小剂量组的治疗方案:ACTH 1 U/(kg·d)加入60 mL 5%葡萄糖溶液中持续泵入6 h,连用2周,治疗有效,再用2周;治疗无效,加量至25 U/d,再用2周,总疗程4周。大剂量组的治疗方案:ACTH 起始剂量25 U/d,连用2周,治疗有效,再用2周;治疗无效,加量至40 U/d,再用2周,总疗程4周。两组患儿均在ACTH治疗结束后复查脑电图(EEG),并改为口服泼尼松,开始剂量为2 mg/kg,移行减量,总疗程为3个月。结果:大剂量组和小剂量组痉挛发作完全控制率分别为53.33%、46.67%,治疗有效率分别为23.33%、26.67%,两组比较差异均无统计学意义(P均>0.05);但小剂量组高血压、肥胖、易激惹、睡眠障碍发生率均低于大剂量组(P均<0.05)。结论:小剂量ACTH治疗IS疗效与大剂量ACTH相当,但不良反应较少。 |
| 关键词: 促肾上腺皮质激素 婴儿痉挛 小剂量 |
| DOI：doi: 10.13407/j.cnki.jpp.1672-108X.2017.11.006 |
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| 基金项目: |
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| Clinical Efficacy and Side Effect of Different Doses of Adrenocorticotropic Hormone for Infantile Spasms |
| Zhu Lina 1, Wang Caixia 2, He Fang 1, Wang Yongxia 1, Ma Xiuwei 1 |
| (1. Affiliated Bayi Children's Hospital, PLA Army General Hospital, Beijing 100700, China; 2. The Fourth Hospital of Baotou, Inner Mongolia Baotou 014000, China) |
| Abstract: |
| Objective: To compare the clinical efficacy and side effects of different doses of adrenocorticotropic hormone (ACTH) therapy for infantile spasms (IS) and offer clinical experience. Methods: Clinical data of 60 cases of IS who were treated with ACTH were investigated. They were admitted to our hospital from January 2012 to December 2015. Sixty children were randomly divided into low-dose group and high-dose group. Each group had 30 children. For the low-dose group, ACTH 1 U/(kg·d) and 60 milliliter 5%
glucose solution were injected for 2 weeks. If therapy was effective, ACTH in the same dose was injected for the subsequent 2 weeks. If an effective response was absent, the dosage of ACTH was increased to 25 U per day for the subsequent 2 weeks. The total course of ACTH was 4 weeks. For the high-dose group, ACTH 25 U per day was injected for 2 weeks. If therapy was effective, ACTH in the same dose was injected for the subsequent 2 weeks. If an effective response was absent, the dosage of ACTH was increased to 40 U per day for the subsequent 2 weeks. The total course of ACTH was 4 weeks. After treatment, patients of two groups accepted electroencephalogram (EEG) inspection and ACTH administration was replaced by oral prednisone acetate 2 mg/ kg per day. Prednisone acetate tapered to zero, total course was 3 months. Results: Complete control rate of spasms was achieved in 53.33% of the high-dose group and 46.67% of the low-dose group. Effective rate was achieved in 23.33% of the high-dose group and 26.67% of the low-dose group. No significant difference on treatment efficacy was found between the two groups (P>0.05). Side effects of high-dose group were more than low-dose group. Significant differences on hypertension, obesity, irritability and sleep disorders were found seen between the two groups (P<0.05). Conclusion: This study shows similar treatment efficacy between two groups. Low-dose ACTH has less side effects compared with high-dose one. |
| Key words: adrenocorticotropic hormone infantile spasms low-dose |
