甲泼尼龙用于抗癫痫药物治疗失败小儿癫痫的效果及影响因素

摘要

目的 探讨甲泼尼龙用于抗癫痫药物(AEDs)治疗失败小儿癫痫的效果及影响因素.方法 选取90例AEDs治疗失败的癫痫患儿作为研究对象,均应用甲泼尼龙进行治疗.治疗1个月后计算治疗有效率与脑电图转归结果 ,并记录患儿不良反应发生情况.根据治疗效果将患儿分为有效组与无效组,比较2组患儿的临床特征,包括病程、月发作频率、早期智能障碍、热性惊厥史和既往用药数量等,明确甲泼尼龙用于AEDs治疗失败小儿癫痫的疗效影响因素.结果90例患儿的治疗总有效率为64.4％;42例高峰失律患儿的临床转归率为4.8％,48例尖波、棘波、棘慢波患儿的临床转归率为4.2％.患儿不良反应总发生率为31.1％.治疗有效组中月发作频率≤4次/月与既往用药数量≤4种的患儿所占百分率分别为62.1％ 和58.6％,均高于无效组(P<0.05).多因素Logistic回归分析显示,既往用药数量≥4种与月发作频率≥4次/月为甲泼尼龙用于AEDs治疗失败小儿癫痫疗效不佳的危险因素.结论 甲泼尼龙用于A EDs治疗失败小儿癫痫可进一步缓解患儿病情,但既往用药数量≥4种与月发作频率≥4次/月的患儿疗效不佳,临床应用时需综合分析.%Objective To investigate the effects of methylprednisolone in the treatment of epilepsy children with antiepileptic drugs (AEDs) treatment failure and the influencing factors of efficacy .Methods 90 epilepsy children with antiepileptic drugs (AEDs) treatment failure were enrolled in the study and all of them were treated with methylprednisolone .After 1 month of treatment ,the effective rate of treatment and the outcome of EEG were calculated ,and the adverse reactions were recorded .According to the treatment effect ,the subjects were divided into the effective group and the ineffective group .The clinical characteristics were com-pared between the 2 groups ,including course of disease ,monthly seizure frequency ,early disturbance intelligence ,history of febrile convulsion and amount of drug used .The influencing factors of efficacy of methylprednisolone were analyzed .Results The total ef-fective rate of treatment was 64 .4％ .The clinical outcome rate in 42 children with hyperarrhythmia was 4 .8％ ,and the clinical outcome rate in 48 children with sharp wave ,spike wave and spike slow wave was 4 .2％ .The total incidence of adverse reactions was 31 .1％ .In the effective group ,the proportions of children whose monthly seizure frequency ≤4 times per month and used drugs ≤4 kinds (62 .1％ and 58 .6％ ) were higher than the proportions in the ineffective group (P<0 .05) .Multivariate logistic regression analysis showed that the used drugs ≥4 kinds and monthly seizure frequency ≥4 times per month were the risk factors for poor effects of methylprednisolone in epilepsy children with AEDs treatment failure .Conclusion The application of methylpred-nisolone in epilepsy children with AEDs treatment failure can relieve the condition of disease ,and the effect in children whose used drug ≥ 4 kinds and monthly seizure frequency ≥4 times per month is poor ,which needs a comprehensive analysis before applica-tion .