摘要目的 观察婴儿痉挛症(IS)患儿不同方案治疗无临床发作后痉挛发作复发的情况,分析影响复发的危险因素.方法 选择2011年5月至2013年9月在江西省儿童医院神经内科住院治疗且痉挛发作获得缓解28 d以上的69例IS患儿为研究对象,随访患儿至痉挛发作复发,未复发者至少随访1年.通过文献复习选定可能影响IS复发的8个可能的影响因素:性别、起病年龄、病程、病因、脑电图高度失律类型、发育商、起效时间、治疗方案,采用Logistic多元回归分析以上各种潜在因素与IS复发的关系.结果 1.在随访治疗后6个月和12个月时,总体样本复发率分别为40.6％(28/69例)和43.5％(30/69例).2.影响复发的各潜在因素中,起病年龄和起效时间与复发关系密切,即非经典型(早发型和晚发型)IS患儿(14/21例,66.7％)较经典型IS患儿(16/48例,33.3％)更易复发(x2=6.605,P=0.010);起效时间＞1周的IS患儿复发率(14/22例,63.6％)高于起效时间1周以内者(16/47例,34.0％)(x2=5.341,P=0.021),且组间差异均有统计学意义(P均＜0.05).3.Logistic多元回归进一步分析提示起病年龄(Wald=3.603)与IS复发关系最密切.结论 1.IS患儿的复发率较高,多集中于0.5年内复发,对其应注重探索长期、合理、有效的临床管理方案.2.起病年龄、起效时间是IS患儿复发的重要因素,且以起病年龄影响最为明显,起效时间次之.因此,早期诊断、早期治疗有可能提高IS疗效,减少复发并改善预后.

abstractsObjective To analyze the potential risk factors of infantile spasms (IS) relapse through following up the respondents with IS after different treatment protocols.Methods Sixty-nine cases were collected in the Department of Pediatric Neurology,Jiangxi Children's Hospital from May 2011 to September 2013,who had complete cessation of spasms for at least 28 days or more after the different treatment protocols.The follow-up was performed on these patients until spasms seizure relapse or at least 1 year for those without recurrence.According to the literature review,8 possible risk factors of IS recurrence (gender,age of onset,course of diseases,etiology,high irregular types of electroencephalogram,development quotient,onset time,treatment protocols) were selected,and then Logistic multiple regression was used to analyze the relationship of various potential risk factors with the relapse of spasms.Results (1) The recurrence rate at 6 months and 12 months were 40.6％ (28/69 cases)and 43.5 ％ (30/69 cases),respectively.(2) Among the various potential factors,the age at onset and the time to response were closely related to the IS recurrence.Namely,the non-classic onset(early-onset and late-onset) of IS were more likely to relapse than the classic onset[66.7％ (14/21 cases) vs 33.3％ (16/48 cases),x2 =6.605,P =0.010];the responders beyond 1 week were more likely to relapse than those within 1 week[63.6％ (14/22 cases) vs 34.0％ (16/47 cases),x2 =5.341,P =0.021].There were significant differences between the 2 groups (all P ＜ 0.05).(3) Logistic multiple regression analysis demonstrated that age at onset (Wald =3.603) was most closely related to the relapse of spasms.Conclusions (1) The relapse rate of IS in children was high,and the majority of them relapsed within 6 months.So a long-term,rational and effective clinical management solution should be explored.(2) The age at onset and the time to response are very important risk factors of the IS recurrence,and the former was more significant.So,early diagnosis and early treatment are more likely to improve the efficacy of IS,and reduce the risks of recurrence and improve the prognosis.