生酮饮食疗法治疗儿童难治性癫痫疗效及安全性的系统评价

doi:10.3760/cma.j.cn441417-20250220-13010

摘要/Abstract

摘要：

目的　系统评价生酮饮食（KD）疗法治疗儿童难治性癫痫的疗效及安全性，为儿童难治性癫痫的临床治疗提供循证依据。方法　检索PubMed、中国知网、万方数据库等文献数据库，搜集有关KD方案治疗难治性癫痫的中英文文献，检索时限从建库至2024年12月31日，提取文献中疗效及安全性相关资料。质量评价采用Cochrane偏倚风险评估工具，并采用RevMan 5.4.1软件进行meta分析。结果　共纳入15项研究，1 218例患儿。meta分析结果显示：观察组KD方案治疗儿童难治性癫痫的总有效率、Gesell评分、生活质量、脑电图改善率高于对照组方案，β-羟基丁酸水平低于对照组方案（均P<0.05）；观察组KD方案治疗儿童难治性癫痫治疗后白细胞介素（IL）-17A水平低于治疗前（P<0.05）。结论　KD疗法可一定程度降低儿童难治性癫痫发作频率，促进生长发育和生活质量的提高，安全性良好，但不同类型KD方案间未见明显的疗效差异，临床可根据患儿具体情况选择合适方案。

关键词: 难治性癫痫, 儿童, 生酮饮食, meta分析

Abstract:

Objective　To systematically evaluate the efficacy and safety of ketogenic diet (KD) therapy for the treatment of refractory epilepsy in children, and to provide an evidence-based basis for the clinical treatment of refractory epilepsy in children. Methods　Literature databases such as PubMed, China National Knowledge Infrastructure, and Wanfang database were searched to collect Chinese and English literatures on KD regimen for refractory epilepsy, and the search time limit was from the establishment of the databases to December 31, 2024, to extract the efficacy and safety related information in the literatures. Quality evaluation was performed using the Cochrane Risk of Bias Assessment Tool, and meta-analysis was performed using RevMan 5.4.1 software. Results　A total of 15 studies with 1 218 children were included. The results of the meta-analysis showed that the total effective rate, Gesell score, quality of life, and electroencephalogram improvement rate of the KD regimen in the observation group for treating refractory epilepsy in children were higher than those of the control group regimen, while the level of β-hydroxybutyric acid was lower than that of the control group regimen (all P<0.05); the level of interleukin (IL)-17A after treatment in children with refractory epilepsy treated by the observation group KD regimen was lower than that before treatment (P<0.05). Conclusions　KD therapy can reduce the frequency of refractory epileptic seizures in children to a certain extent, promote growth and development, and improve the quality of life, with good safety. However, there is no obvious difference in efficacy among different types of KD regimens, and the clinic should choose the appropriate regimen according to the children's specific conditions.

Key words: Refractory epilepsy, , Children, , Ketogenic diet, , Meta-analysis

李蓓何方园贾珊珊.

生酮饮食疗法治疗儿童难治性癫痫疗效及安全性的系统评价 [J]. 国际医药卫生导报, 2025, 31(13): 2160-2166.

Li Bei, He Fangyuan, Jia Shanshan.

Efficacy and safety analysis of ketogenic diet therapy for refractory epilepsy in children: a meta-analysis [J]. International Medicine and Health Guidance News, 2025, 31(13): 2160-2166.

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