两种剂量ACTH治疗婴儿痉挛的疗效及不良反应对比分析

目的 采用回顾性对照实验评价两种不同剂量促肾上腺皮质激素(ACTH)治疗婴儿痉挛(West综合征)的疗效和不良反应.方法 78例婴儿痉挛患儿纳入研究,其中小剂量组42例患儿(隐源性13例,症状性29例),给予ACTH 1 IU/(kg·d)静滴治疗;常规剂量组36例患儿(隐源性10例,症状性26例),给予ACTH 25 IU/d静滴治疗,疗程均为4周,4周后对其临床疗效、脑电图改变、不良反应等进行对比分析.同时应用Logistic回归对可能影响疗效的因素进行分析.结果 小剂量组与常规剂量组有效率分别为71.4%和61.1%(P>0.05),脑电图缓解率分别为69.0%和63.9%(P>0.05),不良反应发生率分别为14.3%和38.9%(P<0.05),疗效与病因及病程显著相关(P<0.05),隐源性与症状性有效率分别为86.3%和57.1%(P<0.05),病程小于等于1月者与大于1月者有效率分别为79.4%和54.5%(P<0.05).结论 小剂量ACTH短期疗效明显,不良反应少,患儿耐受性良好,可以在临床上推荐应用.

A comparative study on the efficacy and adverse reactions of two different dosages of adrenocorticotropic hormone therapy for infantile spasms

Objective  To evaluate the therapeutic efficacy and adverse reaction of two different dosages of adrenocorticotropic hormone (ACTH)for infantile spasms by a retrospective study. Methods  A total of 78 children with infantile spasms were divided into two groups: the low dose group including 13 cryptogenic and 29 symptomatic cases were given ACTH 1IU／(kg·d), and the conventional dose group including 10 cryptogenic and 26 symptomatic cases were given ACTH 25～40IU／(kg.d). The two groups were both administered for four weeks. Then, the clinical efficacy, changes of EEG, and adverse reactions were compared with each other. At the same time, the factors that may affect therapeutic efficacy were analyzed with logistic regression. Results  (1) There was no statistical difference in response rate between the low dose and conventional dose groups(71.4％ vs 61.1％, P>0.05). (2) There was no statistical difference in remission rate of EEG between the low dose and conventional dose groups(69.0％ vs 63.9％,P>0.05). (3) Therapeutic efficacy was significantly related to the pathogenesis and course of the disease. There was a statistical difference in response rate between the cryptogenic and symptomatic children (86.3％ vs 57.1％, P<0.05); there was a statistical difference in response rate between the children whose disease duration was≤one month and those whose disease duration was> one month (79.4％ vs 54.5％, P<0.05). (4) There was a statistical difference in the adverse reaction between the conventional dose and low dose groups(14.3％ vs 38.9％, P<0.05). Conclusion  Low-dose ACTH has an obvious short-term therapeutic efficacy and less adverse reaction, so it can be recommended for the treatment of infantile spasms.