生酮饮食联合丙戊酸钠缓释片治疗老年痉挛发作类癫痫的效果

目的探讨生酮饮食联合丙戊酸钠缓释片治疗老年痉挛发作类癫痫的临床效果。方法老年痉挛发作类癫痫患者56例,按照随机数字表法分为对照组28例,以常规托吡酯片治疗;观察组28例,采用生酮饮食联合丙戊酸钠缓释片治疗,对比两组的治疗效果。结果治疗总有效率对比,观察组显著高于对照组(P0.05);治疗1、2个月后,观察组认知功能评分均明显高于对照组(P0.05),且癫痫发作次数及持续时间均明显优于对照组(P0.05),不良反应发生率明显低于对照组(P0.05)。结论生酮饮食联合丙戊酸钠缓释片在减轻老年痉挛发作类癫痫患者病情方面效果显著。     

生酮饮食不良反应的研究进展

生酮饮食(KD)可以限制热量和液体的摄入,几个世纪以来一直被用于癫痫的治疗,具有显著的治疗效果。近年来,KD在其他疾病领域被证实具有治疗效果,如肥胖、糖尿病、高血压、癌症、阿兹海默病等慢性疾病。尽管KD对多种疾病的治疗具有积极的效果,但由于KD过程对脂肪的高比例摄入,以及对碳水化合物、蛋白质和微量元素的摄入过少,会导致营养吸收的极不均衡。因此,使用KD治疗疾病可能引起多种不良反应,其长期利弊更是争议的热点。本篇综述重点阐述KD的不良反应以及防治手段,以期对临床安全有效地应用KD提供指导帮助。     

生酮饮食在糖尿病治疗中的价值分析

生酮饮食也称为高脂低碳饮食,指的是一种以高脂肪、低碳水为主的饮食方式,同时配合适量蛋白质,形成生酮饮食方案.早期生酮饮食方案在癫痫的治疗中取得了一定成果,饮食干预下形成了酮体模拟饥饿状态,在抑制癫痫发病方面收效显著,甚至达到了替代药物治疗作用.随着临床对生酮饮食研究的不断深入,该饮食方案已逐步运用于糖尿病等代谢性疾病、...     

糖尿病患者采用生酮饮食效果的Meta分析

目的系统评价国内外采用生酮饮食治疗糖尿病患者的效果,从而更好地为糖尿病患者的饮食管理和综合治疗提供循证依据。方法通过检索PubMed、Cochrane Library、EMbase、Sinomed、万方医学网、维普网等数据库,收集国内外对糖尿病患者使用生酮饮食治疗的随机对照试验(RCT),试验组给予低碳生酮饮食,对照组给予低卡路里食物或者平板健康餐,对所纳入的文献采用Jadad评分进行质量评价,使用Review Manager5.3软件进行Meta分析。将试验组和对照组的糖化血红蛋白含量、体重、甘油三酯水平等结局指标进行比较。结果该次Meta分析共纳入文献7篇,其中试验组200例病例,对照组155例病例。Meta分析结果显示,试验组糖化血红蛋白含量低于对照组[MD=-0.50,95%CI(-0.70,-0.30),P<0.01];试验组体重低于对照组[MD=-8.07,95%CI(-10.73,-5.40),P<0.01];试验组甘油三酯水平低于对照组[MD=-29.05,95%CI(-45.50,-12.71),P<0.01]。结论生酮饮食是一种能够有效降低糖尿病患者糖化血红蛋白含量,减轻体重,降低甘油三酯水平的膳食疗法。     

生酮饮食在大鼠心肌缺血再灌注损伤中的保护作用

目的 研究生酮饮食（KD）在大鼠心肌缺血再灌注损伤中的保护作用.方法 分别给予SD雄性大鼠正常饮食（ND）和KD 6周后,结扎大鼠冠状动脉左前降支30 min,恢复再灌注60 min,通过观察心电图和心肌酶学指标,评价KD对大鼠心肌缺血再灌注损伤的保护作用.结果 KD减轻了大鼠心肌缺血再灌注损伤引起的ST段抬高,降低了乳酸脱氢酶和肌酸激酶的水平.结论 KD对大鼠心肌缺血再灌注损伤具有保护作用.     

生酮饮食诱导db/db小鼠肝脏脂肪沉积

目的 ：研究生酮饮食（ketogenic diet,KD）对db/db小鼠肝脏脂质沉积的影响及其机制,探讨KD治疗db/db小鼠的安全性。方法：选用8周龄db/db雄性小鼠20只作为肥胖2型糖尿病（type 2 diabetes mellitus,T2DM）动物模型,适应性喂养3周后,最终18只纳入研究,随机数字表法分为正常喂养（ND）组、KD组、75%热量限制（calorie restriction,CR）组,每组6只。另将8周龄C57BL/6雄性小鼠6只作为正常对照（C）组,以标准饲料喂养。C组、ND组自由进食标准饲料,KD组自由进食生酮饲料,CR组作为阳性对照组,每日摄入ND组75%的标准饲料。干预4周后,由于实验过程中KD组及CR组分别有2只及1只小鼠不明原因死亡,按随机数字表法每组纳入3只小鼠进行统计分析。检测各组小鼠空腹甘油三酯（triglyceride,TG）、总胆固醇（total cholesterol,TC）及低密度脂蛋白胆固醇（low density lipoprotein cholesterol,LDL-C）水平;观察小鼠肝脏形态和结构及肝脏组织中脂滴大小和数量;...     

生酮饮食对肥胖型哮喘的影响

肥胖和支气管哮喘（以下简称哮喘）之间的相关性日益受到关注,70%难治性哮喘患者超重或肥胖,肥胖已成为哮喘的重要危险因素。近年来,生酮饮食作为自然疗法之一,被证实有治疗肥胖症的作用,并且也有研究指出生酮饮食可降低哮喘气道炎症。本文总结了肥胖与哮喘的关联机制,阐述了生酮饮食影响肥胖型哮喘的潜在机制,如控制体重,减轻炎症反应...     

癫痫药物治疗新进展

本文综述近期美国食品药物管理局批准使用的三种新型抗癫痫药物的作用机制，药物代谢动力学及药效学等问题，三药的共同特点是安全、疗效肯定和作用范围较广。     

癫痫的药物治疗现状及其进展

癫痫是一种常见的神经系统慢性发作性疾病，据流行病学调查显示，我国癫痫患病率为4．4‰～4．8‰，依此计算全国大约有600万人罹患癫痫。其中以儿童及青少年居多，对人类的危害较大。20世纪60年代以前，抗癫痫药物极其贫乏，主要限于抗痫谱较窄，副性反应大的溴剂、巴比妥盐、苯二氮卓类及苯妥英等，60年代先后研制出丙戊酸和卡马西平，使癫痫的治疗取得了长足的进步，但仍有20％左右的患者得不到有效的控制。近年来随着对癫痫发病机制认识的深入，终于迎来了新型抗癫痫药物上市的高潮。     

Introduction of a ketogenic diet in young infants

The ketogenic diet is a rational treatment for pyruvate dehydrogenase complex deficiency (McKusick 312170) and GLUT1 deficiency syndrome (McKusick 138140). An increasing number of patients are diagnosed in early infancy, but few data are available on the introduction of a ketogenic diet in this age group. GLUT1 deficiency syndrome was suspected in four infants presenting with seizures and unexplained hypoglycorrhachia. A ketogenic diet was introduced at 6–28 weeks of age. Ketosis was initiated by fasting, monitored by bedside blood glucose and 3-hydroxybutyrate determinations, and was maintained successfully using supplemented carbohydrate-free infant formula and emulgated triglycerides. All patients developed ketosis within 24h. 3-Hydroxybutyrate concentrations available at the bedside correlated inversely with the base excess. At glucose levels 40mg/dl patients remained asymptomatic in the presence of ketones. The ketogenic formula was tolerated well, parental compliance was good, and all patients remained seizure-free on the diet. GLUT1 deficiency was confirmed in two patients; the diet was discontinued in the other two patients. In one infant, failure to thrive on medium-chain triglycerides was effectively reversed using long-chain triglycerides. Urine dipstick analyses failed to detect ketosis in another infant. Adverse effects of the diet were limited to renal stones in one patient. The ketogenic diet can be introduced and maintained successfully in young infants using long-chain fat emulsion. Monitoring 3-hydroxybutyrate at the bedside was useful for metabolic control and superior to urine dipstick analysis. Seizure control was effective and adverse effects were limited, but evaluation of the long-term effects of the ketogenic diet in this age group must await ongoing studies.     

颅脑损伤后癫痫发作的研究进展

颅脑损伤（TBI）后癫痫发作是严重TBI后常见的并发症,根据发作时间可分为即刻或早期的（≤7 d）TBI后抽搐发作和晚期的（>7 d）TBI后继发性癫痫。癫痫发作不仅导致TBI后早期并发症和死亡率升高,而且也是TBI后数年死亡的主要原因。许多对TBI后癫痫发作机制的研究取得了成果,但仍有很多等待解决的问题。药物预防主要用于早期癫痫发作,但对TBI后晚期癫痫几乎没有预防效果。对于TBI后药物难治性癫痫,可以考虑进行癫痫灶切除或神经调控手术。     

False-positive breath-alcohol test after a ketogenic diet

A 59-year-old man undergoing weight loss with very low calorie diets (VLCD) attempted to drive a car, which was fitted with an alcohol ignition interlock device, but the vehicle failed to start. Because the man was a teetotaller, he was surprised and upset by this result. VLCD treatment leads to ketonemia with high concentrations of acetone, acetoacetate and beta-hydroxybutyrate in the blood. The interlock device determines alcohol (ethanol) in breath by electrochemical oxidation, but acetone does not undergo oxidation with this detector. However, under certain circumstances acetone is reduced in the body to isopropanol by hepatic alcohol dehydrogenase (ADH). The ignition interlock device responds to other alcohols (e.g. methanol, n-propanol and isopropanol), which therefore explains the false-positive result. This 'side effect' of ketogenic diets needs further discussion by authorities when people engaged in safety-sensitive work (e.g. bus drivers and airline pilots) submit to random breath-alcohol tests.     

Long-term effects of a ketogenic diet in obese patients

BACKGROUND:

Although various studies have examined the short-term effects of a ketogenic diet in reducing weight in obese patients, its long-term effects on various physical and biochemical parameters are not known.

OBJECTIVE:

To determine the effects of a 24-week ketogenic diet (consisting of 30 g carbohydrate, 1 g/kg body weight protein, 20% saturated fat, and 80% polyunsaturated and monounsaturated fat) in obese patients.

PATIENTS AND METHODS:

In the present study, 83 obese patients (39 men and 44 women) with a body mass index greater than 35 kg/m², and high glucose and cholesterol levels were selected. The body weight, body mass index, total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, fasting blood sugar, urea and creatinine levels were determined before and after the administration of the ketogenic diet. Changes in these parameters were monitored after eight, 16 and 24 weeks of treatment.

RESULTS:

The weight and body mass index of the patients decreased significantly (P<0.0001). The level of total cholesterol decreased from week 1 to week 24. HDL cholesterol levels significantly increased, whereas LDL cholesterol levels significantly decreased after treatment. The level of triglycerides decreased significantly following 24 weeks of treatment. The level of blood glucose significantly decreased. The changes in the level of urea and creatinine were not statistically significant.

CONCLUSIONS:

The present study shows the beneficial effects of a long-term ketogenic diet. It significantly reduced the body weight and body mass index of the patients. Furthermore, it decreased the level of triglycerides, LDL cholesterol and blood glucose, and increased the level of HDL cholesterol. Administering a ketogenic diet for a relatively longer period of time did not produce any significant side effects in the patients. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously demonstrated.     

Protein sparing during treatment of obesity: ketogenic versus nonketogenic very low calorie diet.

Although it is generally agreed that both ketogenic and nonketogenic very low calorie diets promote weight reduction, there is no consensus on a preference of one diet over the other in regard to protein sparing. In the present study, we compared the effects of isocaloric (600 kcal/d) and isonitrogenous (8 g nitrogen/d) ketogenic (low carbohydrate) and nonketogenic diets on parameters of protein and amino acid metabolism, in 16 morbidly obese women maintained on these diets for 4 weeks while confined to a metabolic ward. Cumulative urinary nitrogen excretion (g/4 wk) was significantly (P less than .01) greater (248 +/- 6 v 207 +/- 12, mean +/- SEM, n = 8), and cumulative nitrogen balance significantly (P less than .02) more negative (-50.4 +/- 4.4 v -18.8 +/- 5.7), during treatment with the ketogenic than with the nonketogenic diet. Plasma leucine concentration (mumol/L) was significantly higher (P less than .05) during treatment with the ketogenic than with the nonketogenic diet at day 14 (210 +/- 17 v 150 +/- 8), but not at day 28 (174 +/- 9 v 148 +/- 8). Whole-body rates of leucine oxidation (mmol/h) were significantly higher (P less than .05) during treatment with the ketogenic than with the nonketogenic diet at day 14 (1.29 +/- 0.20 v 0.92 +/- 0.10) and at day 28 (1.00 +/- 0.16 v 0.75 +/- 0.10). Conversely, proteolysis, as measured by leucine turnover rate and urinary excretion of 3-methylhistidine, was not significantly different between the diets.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sex-specific effects of ketogenic diet after pre-exposure to a high-fat,high-sugar diet in rats

Background and aimsThe objectives were to evaluate the relationship between ketogenic diets, the ketone body beta-hydroxybutyrate (BHB), parameters known to increase risk for cardiovascular and metabolic diseases in both sexes, using a pre-clinical model of obesity.Methods and resultsRats had access to a diet high in fat and sugar (HFS) for 12 weeks. After HFS, they switched to chow (HFS–CH) or ketogenic diet (HFS-KD) for 3 weeks to model a dietary intervention. Body weight, adiposity, and food intake were measured. Glucose tolerance and corticosterone response to stress were measured after HFS, then again after the intervention. Both sexes increased body weight, food intake, and adiposity compared to control (CTL) while on HFS. HFS females showed impaired glucose tolerance. HFS males developed a dampened corticosterone to stress, whereas HFS females developed an exacerbated response. The effects of HFS on adiposity and corticosterone were reversed in HFS–CH males. These same improvements were observed in HFS–CH females, although they still had impaired glucose tolerance. HFS-KD males showed some improvements, however, they still had higher body weight and adiposity than CTL. The same pattern was observed in females. These beneficial effects of KD correlated with plasma BHB levels in females but not in males.ConclusionsThese data model effects reported in clinical literature and serve as a valuable translational tool to further test causal mechanisms that lead to desirable outcomes of KD. These sex-specific relationships are important, as KD could potentially affect endocrine mechanisms differently in males and females.     

Consuming a ketogenic diet leads to altered hypoglycemic counter-regulation in mice

Ketogenic diets (KDs) are becoming increasingly popular for the treatment of diabetes, yet they are associated with increased frequency of hypoglycemia. Here we report that mice fed a KD display blunted glucagon release to hypoglycemia and neuroglucopenia, suggesting that consuming a KD may increase the risk for iatrogenic hypoglycemia.