The Effect Of ACTH On Infantile Spasm And Its Influencing Factors In Different Treatment Time

ObjectBased on statistical analysis of clinical data of infantile spasm syndrome(IS)in multi-center institutions,the analysis of the clinical response rate and related influenci ng factors of IS patients in different treatment courses of adrenocorticotropic hormone(ACTH)is as follows:The IS diagnosis and treatment in the area provides a reference basis.Methods1.Establish a data questionnaire to collect basic information and physical examin ation of 127 patients who were diagnosed with IS and given ACTH at Qilu Hospital of Shandong University,Shandong Provincial Hospital,and Jinan Children’s Hospital fr om January 2015 to June 2019,Medical history data,auxiliary examination,treatment and clinical remission;2.All patients were followed up for at least 6 months;3.Follow up all IS patients and select relevant exposure factors that affect clinica 1 response rate for analysis;4.SPSS 25.0 software was used to analyze and process the data.Mean ± standar d deviation(x±s)was used for measurement data conforming to normal distribut ion,and median and quartile spacing were used for measurement data not conforming to normal distribution.The counting information is expressed as frequency or as a per centage(%).In single factor analysis,the counting data were tested by χ~2 test or Fish er’s exact probability method.In the multi-factor analysis,the binary Logistics regress ion model is adopted.Test level α=0.05 is the test level.Results1.General information:127 IS cases were included in this study,including 88(69.3%)males and 39(30.7%)females.Male:female=2.26.1.The onset time was 2-695 days,91-365 days and 100 cases(79%),with a median of 180 days.2.Clinical manifestations:of 127 patients,66(52.0%)had flexion spasm,14(11.0%)had extensional spasm,47(37.0%)had mixed spasm,and flexion and mixed spas m were common.The degree of attack was as follows:(1)10(7.9%)had single string attack and one string was less than or equal to 5 times,9(7.1%)had single string attac k and one string was more than or equal to 5 times(3)had series attack and one string attack There were 20 cases(15.8%)under 5,and 88 cases(69.2%)under 5.3.4-week efficacy analysis:The length of ACTH treatment for IS treatment and whether anti-epileptic drugs were added before treatment had no effect on short-term efficacy.The mental and motor development before treatment and the etiology of cran iocerebral MRI were significantly related to short-term clinical remission(P<0.05).A mong them,children with normal mental and motor development before treatment an d no structural changes in brain MRI had higher short-term clinical remission rate.4.3-month efficacy analysis:An analysis of 127 patients treated with ACTH,wh ether the use of antiepileptic drugs before treatment had no effect on the mid-term effi cacy,treatment duration,mental and motor development before treatment,degree and frequency of seizures were significantly related to mid-term clinical remission(P<0.05).Among them,the treatment duration was 28 days,the mental and motor developm ent before treatment was normal,and the number and frequency of attacks were lower.5.6-month efficacy analysis:127 patients treated with ACTH were analyzed.Wh ether or not anti-epileptic drugs were added before treatment had no effect on long-ter m efficacy.Treatment duration,mental and motor development before treatment,age of onset,degree and number of attacks and long-term clinical The remission was signi ficantly correlated(P<0.05).Among them,the 28-day treatment period,the normal m ental and motor development before treatment,the younger age of onset,and the lesse r degree and number of seizures had higher long-term clinical remission rates.6.Adverse reactions:101 cases(79.5%)of the children had adverse reactions,in cluding 92 cases(72.4%)of respiratory system infection,23 cases(18.1%)of electrol yte disorder,and 13 cases(10.2%)of mental system symptoms such as irritability.7.Recurrence:after ACTH treatment,30 children relapsed,ranging from 3 mont hs to 2 years,among which 9 patients(30.0%)were converted to LGS.Conclusions1.ACTH treatment had no significant difference in short-term clinical response r ate for IS syndrome at 4 and 2 weeks,but there was a significant difference in the Ion g-term clinical response rate.2.The addition of anti-epileptic drugs before ACTH treatment has no effect on th e short-term,mid-and long-term clinical response rate of ACTH treatment.3.Age of onset,mental retardation,and structural changes of craniocerebral MRI are the influencing factors for the clinical response rate of ACTH in the treatment of I S.Therefore,the cause of IS should be clarified as soon as possible,and ACTH treatm ent should be performed in time to improve the recovery of patients.4.Respiratory infections are the most common adverse reactions in patients treat ed with ACTH.Therefore,precautions must be taken to prevent infection in patients with IS syndrome treated with ACTH.