婴儿痉挛症应用大剂量甲泼尼龙治疗后复发的危险因素分析
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摘要
目的探讨婴儿痉挛症(infantile spasms,IS)经大剂量甲泼尼龙治疗后复发的危险因素。方法应用大剂量甲泼尼龙治疗、且14d内中止痉挛发作并持续缓解时间≥28d的IS患儿78例,根据随访中(12～42个月)是否复发分为复发组30例和未复发组48例,记录患儿性别、发病年龄、头颅MRI、缺氧史、低血糖史、发病前精神、运动发育史、应用甲泼尼龙治疗时的病程、起效时间、泼尼松口服疗程等资料,采用多因素logistic回归分析IS经大剂量甲泼尼龙治疗缓解后复发的危险因素。结果 2组发病年龄、应用甲泼尼龙治疗时病程、起效时间、发病前精神/运动发育史比较差异有统计学意义(P<0.05);IS非高峰年龄发病(OR=3.224,95%CI:1.148～9.049,P=0.026)、甲泼尼龙起效时间>7d(OR=3.637,95%CI:1.058～12.506,P=0.040)、发病前精神/运动发育落后(OR=6.109,95%CI:1.063～35.090,P=0.042)是IS经大剂量甲泼尼龙治疗缓解后复发的危险因素。结论 IS非高峰年龄发病、药物起效时间晚、发病前精神/运动发育落后是经大剂量甲泼尼龙治疗缓解后复发的危险因素。
Objective To explore the risk factors for the recurrence of infantile spasms(IS)after high-dose methylprednisolone therapy.Method Seventy-eight children with IS which stopped onset within 14 dand sustained relief for≥28 dafter high-dose methylprednisolone therapy,were divided into recurrence group(n=30)and non-recurrence group(n=48)according to the 12-42 months follow-up results.The children's gender,age of IS onset,head MRI,history of hypoxia,history of hypoglycemia,mental and motor developmental history before IS onset,disease course before methylprednisolone therapy,the time to response,and oral administration course of methylprednisolone were recorded.The univariate and multivariate logistic regression analysis methods were used to evaluate the risk factors for recurrence after treatment.Results There were significant differences in the IS onset age,disease course before methylprednisolone therapy,the time to response,and pre-onset mental/motor development history between two groups(P<0.05).IS onset in non-peak age(OR=3.224,95%CI:1.148-9.049,P=0.026),the time to response >7 d(OR=3.637,95%CI:1.058-12.506,P=0.040),and delayed mental/motor development before IS onset(OR=6.109,95%CI:1.063-35.090,P=0.042)were the risk factors for the recurrence of IS after methylprednisolone therapy.Conclusion IS onset in non-peak age,late response to drugs,and delayed mental/motor development before IS onset are the risk factors for the recurrence after treatment with high-dose methylprednisolone.
Objective To explore the risk factors for the recurrence of infantile spasms(IS)after high-dose methylprednisolone therapy.Method Seventy-eight children with IS which stopped onset within 14 dand sustained relief for≥28 dafter high-dose methylprednisolone therapy,were divided into recurrence group(n=30)and non-recurrence group(n=48)according to the 12-42 months follow-up results.The children's gender,age of IS onset,head MRI,history of hypoxia,history of hypoglycemia,mental and motor developmental history before IS onset,disease course before methylprednisolone therapy,the time to response,and oral administration course of methylprednisolone were recorded.The univariate and multivariate logistic regression analysis methods were used to evaluate the risk factors for recurrence after treatment.Results There were significant differences in the IS onset age,disease course before methylprednisolone therapy,the time to response,and pre-onset mental/motor development history between two groups(P<0.05).IS onset in non-peak age(OR=3.224,95%CI:1.148-9.049,P=0.026),the time to response >7 d(OR=3.637,95%CI:1.058-12.506,P=0.040),and delayed mental/motor development before IS onset(OR=6.109,95%CI:1.063-35.090,P=0.042)were the risk factors for the recurrence of IS after methylprednisolone therapy.Conclusion IS onset in non-peak age,late response to drugs,and delayed mental/motor development before IS onset are the risk factors for the recurrence after treatment with high-dose methylprednisolone.
引文
[1]WILMSHURST J M,IBEKWE R C,O'CALLAGHAN F J.Epileptic spasms-175years on:trying to teach an old dog new tricks[J].Seizure,2017,44:81-86.
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[6]张晓莉,杜开先,董燕,等.甲强龙冲击治疗婴儿痉挛症的早期疗效评价[J].中国实用神经疾病杂志,2014,17(16):51-52.
[7]贾天明,甘玲,杜开先,等.甲泼尼龙对其他抗癫痫药物治疗失败伴癫痫性痉挛的癫痫性脑病疗效观察[J].中华实用儿科临床杂志,2016,31(12):903-906.
[8]吴逊,李文慧.国际抗癫痫联盟分类和名词委员会推荐的癫痫和癫痫综合征的分类(1989)[J].中华神经科杂志,2001,34(3):187-187.
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[10]陈莹,张月华.婴儿痉挛症的治疗和预后研究进展[J].中国循证儿科杂志,2011,6(1):65-70.
[11]MACKAY M T,WEISS S K,ADAMS-WEBBER T,et al.Practice parameter:medical treatment of infantile spasms:report of the American Academy of Neurology and the Child Neurology Society[J].Neurology,2004,62(10):1668-1681.
[12]OKANISHI T,SUGIURA C,SAITO Y,et al.Long-term weekly ACTH therapy for relapsed West syndrome[J].Pediatr Neurol,2008,38(6):445-449.
[13]KELLEY S A,Knupp K G.Infantile spasms:have we made progress?[J].Curr Neurol Neurosci Rep,2018,18(5):27.
[14]O'CALLAGHAN F J,EDWARDS S W,ALBER F D,et al.Safety and effectiveness of hormonal treatment versus hormonal treatment with vigabatrin for infantile spasms(ICISS):a randomised,multicentre,open-label trial[J].Lancet Neurol,2017,16(1):33-42.
[15]RIIKONEN R S.Favourable prognostic factors with infantile spasms[J].Eur J Paediatr Neurol,2010,14(1):13-18.
[16]BARAM T Z,MITCHELL W G,TOURNAY A,et al.Highdose corticotropin(ACTH)versus prednisone for infantile spasms:a prospective,randomized,blinded study[J].Pediatrics,1996,97(3):375-379.
[17]甘靖,屈艺,罗蓉.婴儿痉挛症治疗进展[J].中华实用儿科临床杂志,2014,29(24):1889-1892.
[18]ARYA R,SHINNAR S,GLAUSER T A.Corticosteroids for the treatment of infantile spasms:a systematic review[J].JChild Neurol,2012,27(10):1284-1288.
[19]YAMADA K,TORIBE Y,KIMIZU T,et al.Predictive value of EEG findings at control of epileptic spasms for seizure relapse in patients with West syndrome[J].Seizure,2014,23(9):703-707.
[20]RIIKONEN R.Long-term otucome of West syndrome:a study of adults with a history of infantile spasms[J].Epilepsia,2010,37(4):367-372.
[2]YEH H R,KIM M J,KO T S,et al.Short-term outcome of intravenous methylprednisolone pulse therapy in patients with infantile spasms[J].Pediatr Neurol,2017,71:50-55.
[3]MYTINGER J R,QUIGG M,TAFT W C,et al.Outcomes in treatment of infantile spasms with pulse methylprednisolone[J].J Child Neurol,2010,25(8):948-953.
[4]HASSANZADEH RAD A,AMINZADEH V.Infantile spasms treated with intravenous methypredinsolone pulse[J].Iran JChild Neurol,2017,11(2):8-12.
[5]杨庆华,贾天明,邹丽萍,等.大剂量甲泼尼龙冲击治疗婴儿痉挛症的临床分析[J].中国小儿急救医学,2014,21(4):225-227.
[6]张晓莉,杜开先,董燕,等.甲强龙冲击治疗婴儿痉挛症的早期疗效评价[J].中国实用神经疾病杂志,2014,17(16):51-52.
[7]贾天明,甘玲,杜开先,等.甲泼尼龙对其他抗癫痫药物治疗失败伴癫痫性痉挛的癫痫性脑病疗效观察[J].中华实用儿科临床杂志,2016,31(12):903-906.
[8]吴逊,李文慧.国际抗癫痫联盟分类和名词委员会推荐的癫痫和癫痫综合征的分类(1989)[J].中华神经科杂志,2001,34(3):187-187.
[9]LUX A L,OSBORNE J P.A proposal for case definitions and outcome measures in studies of infantile spasms and West syndrome:consensus statement of the West Delphi Group[J].Epilepsia,2004,45(11):1416-1428.
[10]陈莹,张月华.婴儿痉挛症的治疗和预后研究进展[J].中国循证儿科杂志,2011,6(1):65-70.
[11]MACKAY M T,WEISS S K,ADAMS-WEBBER T,et al.Practice parameter:medical treatment of infantile spasms:report of the American Academy of Neurology and the Child Neurology Society[J].Neurology,2004,62(10):1668-1681.
[12]OKANISHI T,SUGIURA C,SAITO Y,et al.Long-term weekly ACTH therapy for relapsed West syndrome[J].Pediatr Neurol,2008,38(6):445-449.
[13]KELLEY S A,Knupp K G.Infantile spasms:have we made progress?[J].Curr Neurol Neurosci Rep,2018,18(5):27.
[14]O'CALLAGHAN F J,EDWARDS S W,ALBER F D,et al.Safety and effectiveness of hormonal treatment versus hormonal treatment with vigabatrin for infantile spasms(ICISS):a randomised,multicentre,open-label trial[J].Lancet Neurol,2017,16(1):33-42.
[15]RIIKONEN R S.Favourable prognostic factors with infantile spasms[J].Eur J Paediatr Neurol,2010,14(1):13-18.
[16]BARAM T Z,MITCHELL W G,TOURNAY A,et al.Highdose corticotropin(ACTH)versus prednisone for infantile spasms:a prospective,randomized,blinded study[J].Pediatrics,1996,97(3):375-379.
[17]甘靖,屈艺,罗蓉.婴儿痉挛症治疗进展[J].中华实用儿科临床杂志,2014,29(24):1889-1892.
[18]ARYA R,SHINNAR S,GLAUSER T A.Corticosteroids for the treatment of infantile spasms:a systematic review[J].JChild Neurol,2012,27(10):1284-1288.
[19]YAMADA K,TORIBE Y,KIMIZU T,et al.Predictive value of EEG findings at control of epileptic spasms for seizure relapse in patients with West syndrome[J].Seizure,2014,23(9):703-707.
[20]RIIKONEN R.Long-term otucome of West syndrome:a study of adults with a history of infantile spasms[J].Epilepsia,2010,37(4):367-372.