KETONEMIA AND SEIZURES - METABOLIC AND ANTICONVULSANT EFFECTS OF 2 KETOGENIC DIETS IN CHILDHOOD EPILEPSY
KETONEMIA AND SEIZURES - METABOLIC AND ANTICONVULSANT EFFECTS OF 2 KETOGENIC DIETS IN CHILDHOOD EPILEPSY
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DOI：
10.1203/00006450-197605000-00006
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发表时间：
1976-01-01
影响因子：
3.6
通讯作者：
HUTTENLOCHER, PR
中科院分区：
文献类型：
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作者：
HUTTENLOCHER, PR
描述了一种新的生酮方案的代谢效应，其中通过喂食中链甘油三酯（MCT）诱导酮血症，并与标准高脂肪生酮饮食的效应进行了比较。18名儿童维持MCT饮食3个月。与标准高脂饮食儿童中观察到的显著高脂血症相反，4岁儿童的血清胆固醇没有升高，血清总脂肪酸仅轻微升高。长期使用MCT饲料不会影响静脉血的pH值。1/3的儿童血糖降至50 mg/100 ml以下，开始饮食后2-3周达到最低水平。血浆D（-）-β-羟丁酸（BHB）和乙酰乙酸在饮食治疗后逐渐升高，约1个月后达到最高水平。在10岁以下的儿童中达到了较高水平的BHB和乙酰乙酸（BHB = 4.3 mM .+-. 0.6 SEM，乙酰乙酸盐= 1.8 mM .+-。0.3 SEM）比10-18奥尔兹（BHB = 1.6 mM . ±. 0.2 SEM，乙酰乙酸盐= 0.57 mM+。0.08 SEM）。维持3：1高脂肪饮食的儿童的血浆BHB和乙酰乙酸酯水平与60% MCT饮食的儿童相似。血浆BHB水平与抗惊厥作用呈显著正相关（P < 0.02）。静脉输注葡萄糖可迅速逆转酮血症和抗惊厥作用。标准生酮饮食和MCT饮食的抗惊厥作用取决于BHB血液水平维持在2 mM以上和乙酰乙酸盐血液水平维持在0.6 mM以上。这些化合物中的一种或两种具有直接抗惊厥作用或在脑代谢中产生快速可逆的变化，这反过来影响脑兴奋性。
Metabolic effects of a new ketogenic regimen in which ketonemia is induced by feeding of medium chain triglycerides (MCT) are described, and comparisons are made with effects of the standard high fat ketogenic diet. Eighteen children maintained on the MCT diet for 3 mo. to 4 yr failed to show elevations of serum cholesterol and had only a slight rise in serum total fatty acids, in contrast to the marked hyperlipidemia observed in children on the standard high fat diet. Long term use of the MCT diet did not affect pH of venous blood. Blood glucose fell below 50 mg/100 ml in 1/3 of the children, the lowest levels being reached 2-3 wk after the start of the diet. Plasma D(-)-.beta.-hydroxybutyrate (BHB) and acetoacetate rose gradually after institution of diet therapy, maximum levels being reached after about 1 mo. Higher levels of BHB and acetoacetate were achieved in children under the age of 10 yr (BHB = 4.3 mM .+-. 0.6 SEM, acetoacetate = 1.8 mM .+-. 0.3 SEM) than in 10-18 yr olds (BHB = 1.6 mM .+-. 0.2 SEM, acetoacetate = 0.57 mM .+-. 0.08 SEM). Plasma BHB and acetoacetate levels in children maintained on a 3:1 high fat diet were similar to those in children on a 60% MCT diet. Plasma levels of BHB showed a significant correlation with anticonvulsant effect (P < 0.02). Both the ketonemia and the anticonvulsant action were reversed rapidly by i.v. infusion of glucose. The anticonvulsant effect of the standard ketogenic diet and of the MCT diet are dependent upon maintenance of blood levels of BHB above 2 mM and of acetoacetate above 0.6 mM. One or both of these compounds either have direct anticonvulsant effects or produce rapidly reversible changes in cerebral metabolism, which in turn affect cerebral excitability.