文章摘要
生酮饮食治疗成人难治性癫痫的疗效:RCT研究的系统评价及Meta分析
Efficacy and Compliance of ketogenic diets in adults with Intractable Epilepsy: A systematic review and meta-analysis of RCT
投稿时间:2022-05-20  修订日期:2022-05-20
DOI:
中文关键词: 生酮饮食  难治性癫痫  系统评价  Meta分析
英文关键词: ketogenic diet (KD)  intractable epilepsy  systematic review  meta-analysis
基金项目:广东省医学科研基金 腺苷激酶调控的腺苷-蛋白激酶C-cAMP信号通路激活BKCa通道:癫痫耐药的启动机制?(A2020312) ; 南山区科技计划项目 生物钟基因Clock在颞叶癫痫中的表达变化(2019002)
作者单位E-mail
李巷 华中科技大学协和深圳医院 lixiang54120@163.com 
董子康 华中科技大学协和深圳医院  
张素平 华中科技大学协和深圳医院  
聂荔 华中科技大学协和深圳医院  
王传明 华中科技大学协和深圳医院  
王成雅 华中科技大学协和深圳医院  
何桂英 华中科技大学协和深圳医院  
杨春水 华中科技大学协和深圳医院 39362849@qq.com 
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中文摘要:
      目的:系统评价生酮饮食对成人难治性癫痫的疗效和依从性。 方法:系统性检索PubMed、Web of Science、Embase和Cochrane 图书馆(Cochrane Library),自建库至 2022 年2 月的RCT文献。由两位研究者独立对文献进行资料提取和质量评价后,使用RevMan软件对纳入文献进行Meta分析。 结果:共纳入4项RCT 研究,其中3项研究为生酮饮食与常规饮食对照,共计纳入221例患者。另外1项研究为不同生酮饮食之间比较,纳入80例患者。结果显示,癫痫发作减少50%及以上有效率方面,荟萃分析支持KD组,但差异无统计学意义。考虑到异质性,仅纳入Zare 2017及Kishk 2021两项研究,有效率为48.65%,差异有统计学意义。失访率荟萃分析显示结果更支持常规饮食,但差异无统计学意义。与单独使用MAD相比,在第一个月用生酮配方补充MAD,患者失访率低,依从性更好。 结论:KD是成人难治性癫痫有希望的补充疗法,耐受性良好。
英文摘要:
      Objective: To evaluate the efficacy and compliance of ketogenic diets in adults with intractable epilepsy. Methods: PubMed, Web of Science, Embase, and the Cochrane Library were systematically searched for RCT studies in adults published up to February 2022. After data extraction and quality evaluation of the studies independently by two researchers, Meta-analysis was performed on the included studies using RevMan software. Results: A total of 4 RCTs were included, 3 of which were ketogenic diets versus conventional diet, with a total of 221 patients. Another study compared different ketogenic diets and included 80 patients. The results showed that the meta-analysis supported the KD group, in terms of the effective rate of 50% or more reduction in seizure frequency, but the difference was not statistically significant. Considering the heterogeneity, only two studies (Zare 2017 and Kishk 2021) were included, and the effective rate was 48.65%. The loss-to-follow meta-analysis showed that the results were more supportive of a regular diet, but the difference was not statistically significant. Supplementation with MAD in the first month with a ketogenic formula resulted in lower loss to follow-up and better compliance than MAD alone. Conclusions: KD is a promising complementary therapy for adults with intractable epilepsy and well tolerated.
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