Miyazaki M, Hashimoto T, Yoneda Y, Saijio T, Mori K, Ito M, Kuroda Y
Department of Pediatrics, School of Medicine, Tokushima University, Japan.
Brain Dev. 1998 Aug;20(5):312-8. doi: 10.1016/s0387-7604(98)00041-2.
To clarify the mechanism of action of adrenocorticotropic hormone (ACTH) in treating infantile spasms, we evaluated the effects of ACTH on the metabolism of pyruvate in the central nervous system (CNS) of children with infantile spasms. We measured the levels of lactate and pyruvate in cerebrospinal fluid (CSF) and serum, before and during ACTH treatment in 12 children with infantile spasms. We evaluated statistically any correlation between the observed metabolic changes and the clinical response of ACTH. ACTH therapy significantly elevated the levels of lactate and pyruvate in the CSF and serum. The effect was not dose-dependent. During ACTH therapy, the serum levels of lactate and pyruvate and the ratio of lactate to pyruvate (L:P ratio) were unrelated to these levels in CSF. Patients who showed a good initial response to treatment had a significantly higher CSF level of pyruvate and a lower L:P ratio during therapy than did those with a poor initial response. This is the first report that ACTH therapy administered for infantile spasms alters pyruvate metabolism in the CNS. This metabolic change may be involved in part in the action of ACTH in relieving infantile spasms.
为阐明促肾上腺皮质激素（ACTH）治疗婴儿痉挛症的作用机制，我们评估了ACTH对婴儿痉挛症患儿中枢神经系统（CNS）丙酮酸代谢的影响。我们测量了12例婴儿痉挛症患儿在ACTH治疗前及治疗期间脑脊液（CSF）和血清中乳酸和丙酮酸的水平。我们对观察到的代谢变化与ACTH的临床反应之间的相关性进行了统计学评估。ACTH治疗显著提高了CSF和血清中乳酸和丙酮酸的水平。该效应不依赖剂量。在ACTH治疗期间，血清中乳酸和丙酮酸的水平以及乳酸与丙酮酸的比值（L:P比值）与CSF中的这些水平无关。治疗初期反应良好的患者在治疗期间CSF中丙酮酸水平显著较高，L:P比值较低，而初期反应较差的患者则不然。这是首篇关于ACTH治疗婴儿痉挛症会改变CNS中丙酮酸代谢的报告。这种代谢变化可能部分参与了ACTH缓解婴儿痉挛症的作用。
