婴儿痉挛症首次促肾上腺皮质激素治疗相关因素与痉挛控制时间的Cox比例风险回归模型分析

Factors in first-time adrenocorticotropic hormone therapy and their influence on spasm control time in infantile spasms: a Cox proportional-hazards regression model analysis

摘要:

目的 探讨婴儿痉挛症患儿首次行促肾上腺皮质激素（ACTH）治疗中的相关因素对痉挛控制时间的影响，为临床治疗提供参考依据。方法 选择2008年1月至2013年10月收治的72例婴儿痉挛症患儿为研究对象，收集临床资料，选取婴儿痉挛症相关暴露因素，以痉挛控制时间分别对各因素进行Cox比例风险回归模型分析，评估各因素对痉挛控制时间的影响。结果 有无明确病因（已知病因或不明原因）、治疗前痉挛发作频率、是否联合治疗（ACTH单用或联合硫酸镁）3个因素对婴儿痉挛症患儿的痉挛控制时间具有显著性影响（P < 0.05）。已知病因的婴儿痉挛症患儿痉挛控制时间较短，而治疗前痉挛发作频率较低以及ACTH联合硫酸镁治疗的患儿痉挛控制时间较长（均P < 0.05）。结论 对于首诊的婴儿痉挛症患儿，应尽可能明确病因，有助于评估预后；及早应用ACTH联合硫酸镁治疗，可能改善预后。

Abstract:

Objective To investigate the factors in first-time adrenocorticotropic hormone (ACTH) therapy and their influence on spasm control time in infants with infantile spasms. Methods A total of 72 infants with infantile spasms who were admitted from January 2008 to October 2013 were enrolled. Their clinical data were collected, and the exposure factors for infantile spasms were selected. A Cox proportional-hazards regression model analysis was performed for these factors to analyze their influence on spasm control time. Results Clarification of the etiology (known or unexplained etiology), frequency of spasms before treatment, and presence or absence of combination therapy (ACTH used alone or in combination with magnesium sulfate) had a significant influence on spasm control time in infants with infantile spasms. The infants with a known etiology had a significantly shorter spasm control time than those with unexplained etiology, and the infants with a low frequency of spasms before treatment and receiving ACTH combined with magnesium sulfate early had a significantly longer spasm control time than their counterparts (P < 0.05). Conclusions For infants with infantile spasms at initial diagnosis, etiology should be clarified, which may helpful for evaluating prognosis. A combination of ACTH and magnesium sulfate should be given as soon as possible, which may improve their prognosis.