[1]乔喜娟,贺孝良.左乙拉西坦和丙戊酸钠对癫痫患儿骨代谢的影响[J].新乡医学院学报,2020,37(9):881-884.[doi:10.7683/xxyxyxb.2020.09.018]
　QIAO Xijuan,HE Xiaoliang.Effects of levetiracetam and sodium valproate on bone metabolism in children with epilepsy[J].Journal of Xinxiang Medical University,2020,37(9):881-884.[doi:10.7683/xxyxyxb.2020.09.018]
点击复制

左乙拉西坦和丙戊酸钠对癫痫患儿骨代谢的影响
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年9
页码:
881-884
栏目:
临床研究
出版日期:
2020-09-05

文章信息/Info

Title:
Effects of levetiracetam and sodium valproate on bone metabolism in children with epilepsy
作者:
乔喜娟1; 贺孝良2
（1.洛阳新区人民医院儿科，河南　洛阳　471023；2.河南科技大学第一附属医院儿科，河南　洛阳　471000）
Author(s):
QIAO Xijuan1; HE Xiaoliang2
(1.Department of Pediatrics，the People′s Hospital of Luoyang New District，Luoyang 471023，Henan Province，China;2.Department of Pediatrics，the First Affiliated Hospital of Henan University of Science and Technology，Luoyang 471000，Henan Province，China)
关键词:
癫痫; 丙戊酸钠; 左乙拉西坦; 骨代谢
Keywords:
epilepsy; valproic acid; levetiracetam; bone metabolism
分类号:
R742.1
DOI:
10.7683/xxyxyxb.2020.09.018
文献标志码:
A
摘要:
目的　探讨左乙拉西坦、丙戊酸钠治疗癫痫的临床效果及其对患儿骨代谢的影响。方法　选择2015年1月至2018年5月洛阳新区人民医院收治的116例癫痫患儿为研究对象，根据治疗方法分为左乙拉西坦组（n=68）和丙戊酸钠组（n=48），另选择同期健康儿童34例作为健康对照组。分别于治疗前及治疗3、6个月时检测左乙拉西坦组和丙戊酸钠组患儿血清碱性磷酸酶（ALP）、钙（Ca2+）、磷（P3-）和25-羟基维生素D［25-(OH)D］水平，健康对照组儿童于体检时检测上述指标；治疗6个月后评估左乙拉西坦组和丙戊酸钠组患儿的临床疗效。结果　治疗前3组儿童血清ALP、Ca2+、P3-、25-(OH)D水平比较差异无统计学意义（P>0.05）。左乙拉西坦组患儿治疗前、治疗3个月和治疗6个月血清ALP、Ca2+、P3-、25-(OH)D水平比较差异无统计学意义（P>0.05）；丙戊酸钠组患儿治疗前、治疗3个月和治疗6个月血清Ca2+、P3-、25-(OH)D水平比较差异无统计学意义（P>0.05），丙戊酸钠组患儿治疗6个月后血清ALP水平高于治疗前和治疗3个月（P<0.05）。治疗3个月后，左乙拉西坦组与丙戊酸钠组患儿血清ALP、Ca2+、P3-、25-(OH)D水平比较差异无统计学意义（P>0.05）；治疗6个月后，左乙拉西坦组与丙戊酸钠组患儿血清Ca2+、P3-、25-(OH)D水平比较差异无统计学意义（P>0.05），丙戊酸钠组患儿血清ALP水平高于左乙拉西坦组（P<0.05）。治疗6个月后，左乙拉西坦组和丙戊酸钠组患儿总有效率分别为83.8%（57/68）、79.2%（38/48），2组患儿治疗总有效率比较差异无统计学意义（χ2=0.412，P>0.05）。结论　左乙拉西坦和丙戊酸钠对癫痫患儿的疗效相当；左乙拉西坦对癫痫患儿骨代谢无显著影响；丙戊酸钠对癫痫患儿骨代谢有一定的影响，因此，应用丙戊酸钠治疗期间应注意监测血清ALP水平。
Abstract:
Objective　To investigate the clinical effect of levetiracetam and sodium valproate in the treatment of epilepsy and its influence on bone metabolism in children.Methods　A total of 116 children with epilepsy admitted to the People′s Hospital of Luoyang New District from January 2015 to May 2018 were selected as the subjects，and they were divided into levetiracetam group (n=68) and valproate group (n=48) according to the therapeutic method.Another 34 healthy children were selected as the healthy control group.The levels of serum alkaline phosphatase (ALP)，calcium (Ca2+)，phosphorus (P3-) and 25-hydroxyvitamin D［25-(OH)D］ were detected before treatment and 3,6 months after treatment.The above indexes were detected in the healthy control group at the time of physical examination.The clinical effect of the children in the levetiracetam group and sodium valproate group was evaluated after 6 months of treatment.Results　There was no significant difference in the levels of serum ALP，Ca2+，P3- and 25-(OH)D among the three groups before treatment (P>0.05).There was no significant difference in the levels of serum ALP，Ca2+，P3- and 25-(OH)D at the time points of before treatment，3 months and 6 months of treatment in the levetiracetam group (P>0.05).There was no significant difference in the levels of serum Ca2+，P3-and 25-(OH)D at the time points of before treatment，3 months and 6 months of treatment in the sodium valproate group (P>0.05).The serum ALP level after 6 months of treatment was higher than that before treatment and 3 months of treatment in the valproate group (P<0.05).There was no significant difference in the levels of serum ALP，Ca2+，P3- and 25-(OH)D between the levetiracetam group and the sodium valproate group after 3 months of treatment (P>0.05).After 6 months of treatment，there was no significant difference in the levels of serum Ca2+，P3- and 25-(OH)D between the levetiracetam group and the sodium valproate group (P>0.05)，the serum ALP level in the valproate group was higher than that in the levetiracetam group (P<0.05).After 6 months of treatment，the total effective rate in the levetiracetam group and the sodium valproate group was 83.8% (57/68) and 79.2% (38/48)，respectively;there was no significant difference in the total effective rate between the two groups (χ2=0.412，P>0.05).Conclusion　The effect of levetiracetam and valproate in the treatment of children with epilepsy is similar.Levetiracetam has no significant effect on bone metabolism in epileptic children；sodium valproate has a certain effect on bone metabolism in children with epilepsy.Therefore，it is necessary to monitor the serum ALP level during the treatment with sodium valproate.

参考文献/References:

［1］　杨圣海，张仲斌，刘明，等.癫痫患儿丙戊酸首次给药剂量的随机对照研究［J］.中华实用儿科临床杂志，2018，33（12）：905-908.
［2］　CAMFIELD P，CAMFIELD C.Incidence，prevalence and aetiology of seizures and epilepsy in children［J］.Epileptic Disord，2015,17(2):117-123.
［3］　GLOBAL BURDEN OF DISEASE CHILD AND ADOLESCENT HEALTH COLLABORATION.Child and adolescent health from 1990 to 2015:findings from the global burden of diseases，injuries，and risk factors 2015 study［J］.JAMA Pediatr，2017,171(6):573-592.
［4］　GE Y，DING D，ZHANG Q，et al.Incidence of sudden unexpected death in epilepsy in community-based cohort in China［J］.Epilepsy Behav，2017,76:76-83.
［5］　王卫平.儿科学［M］.8版.北京：人民卫生出版社，2016：392-400.
［6］　VIDAURRE J，HERBST J.New antiepileptic drugs［J］.Medicina，2019,79 (Suppl 3):48-53.
［7］　SANKARANENI R，LACHHWANI D.Antiepileptic drugs:a review［J］.Pediatr Ann，2015,44(2):e36-e42.
［8］　SVALHEIM S，SVEBERG L，MOCHOL M，et al.Interactions between antiepileptic drugs and hormones［J］.Seizure，2015,28:12-17.
［9］　ARICAN P，GENCPINAR P，CAVUSOGLU D，et al.Levetiracetam monotherapy for the treatment of infants with epilepsy［J］.Seizure,2018,56:73-77.
［10］　丁晶，汪昕.癫痫诊疗指南解读［J］.临床内科杂志，2016，33（2）：142-144.
［11］　中国抗癫痫协会.临床诊疗指南：癫痫病分册［M］.北京：人民卫生出版社，2015：5-25.
［12］　MARTINEZ-JUAREZ I E，MORENO J，LADINO L D，et al.Diagnosis and treatment of non-triggered single epileptic seizures［J］.Rev Neurol，2016,63(4):165-175.
［13］　闫敏，武运红，韩虹，等.新型抗癫痫药物对癫痫患儿骨代谢影响的前瞻性研究［J］.中华实用儿科临床杂志，2020，35（4）：289-292.
［14］　KRISHNAMOORTHY G，KARANDE S，AHIRE N，et al.Bone metabolism alteration on antiepileptic drug therapy［J］.Indian J Pediatr，2009,76(4):377-383.
［15］　万丛超，陈印.丙戊酸钠和奥卡西平对癫痫儿童生长速度和骨代谢的潜在影响［J］.中国临床医生杂志，2019,47（7）：867-869.
［16］　HAMED S A，MOUSSA E M M，YOUSSEF A H，et al.Bone status in patients with epilepsy:relationship to markers of bone remodeling［J］.Front Neurol,2014，5:142.
［17］　ALBAGHDADI O，ALHALABI M S，ALOURFI Z，et al.Bone health and vitamin D status in young epilepsy patients on valproate monotherapy［J］.Clin Neurol Neurosurg，2016，146:52-56.
［18］　CHEN D Y，BIAN H L，ZHANG L L.A meta-analysis of levetiracetam for randomized placebo-controlled trials in patients with refractory epilepsy［J］.Neuropsychiatr Dis Treat，2019,15,905-917.
［19］　NISSEN-MEYER L S H，SVALHEIM S，TAUBLL E，et al.Levetiracetam，phenytoin，and valproate act differently on rat bone mass，structure，and metabolism［J］.Epilepsia，2007，48(10):1850-1860.

相似文献/References:

[1]李冲,尹景岗,许家战,等.可疑癫痫患者24小时磁带记录脑电监测[J].新乡医学院学报,1996,13(03):245.
[2]白海涛,朱凤莲,赵军华.单光子发射计算机断层显像与脑电图联合应用对儿童癫痫的诊断价值[J].新乡医学院学报,2002,19(05):378.
[3]张宁,李文强,杜好瑞,等.癫痫大鼠模型的视频脑电图研究[J].新乡医学院学报,2011,28(06):000.
[4]王耀华.维生素E 辅助治疗儿童癫痫的临床研究[J].新乡医学院学报,2012,29(06):437.
[5]石景鹤,高　静,王家勤.拉莫三嗪对癫痫大鼠学习记忆能力及海马组织中Bax和Bcl-2蛋白表达的影响[J].新乡医学院学报,2017,34(1):010.[doi:10.7683/xxyxyxb.2017.01.003]
　SHI Jing-he,GAO Jing,WANG Jia-qin.Effect of lamotrigine on spatial learning and memory and the expression of Bax and Bcl-2 protein in hippocampus of epileptic rats[J].Journal of Xinxiang Medical University,2017,34(9):010.[doi:10.7683/xxyxyxb.2017.01.003]
[6]申法政,赵新利,金保哲,等.特异性α5亚基γ-氨基丁酸A受体阻断剂对杏仁核电点燃大鼠成功点燃时间的影响[J].新乡医学院学报,2018,35(11):971.[doi:10.7683/xxyxyxb.2018.11.006]
　SHEN Fa-zheng,ZHAO Xin-li,JIN Bao-zhe,et al.Effect of specific α5 subunit-γ-aminobutyrate A receptor blocker on the successful kindling time of almond kindled rats[J].Journal of Xinxiang Medical University,2018,35(9):971.[doi:10.7683/xxyxyxb.2018.11.006]
[7]郝　洁,田小军,吴湘涛,等.任务反馈式游戏活动联合心理行为干预在细菌性脑膜炎后癫痫患儿中的应用效果[J].新乡医学院学报,2021,38(2):184.[doi:10.7683/xxyxyxb.2021.02.019]
　HAO Jie,TIAN Xiaojun,WU Xiangtao,et al.Application effect of task-feedback game activities combined with psychological behavior intervention in children with epilepsy after bacterial meningitis[J].Journal of Xinxiang Medical University,2021,38(9):184.[doi:10.7683/xxyxyxb.2021.02.019]
[8]张俊华,于　明,祁英杰,等.醒脑静注射液联合丙戊酸钠治疗脑卒中后癫痫疗效观察[J].新乡医学院学报,2020,37(9):852.[doi:10.7683/xxyxyxb.2020.09.010]
　ZHANG Junhua,YU Ming,QI Yingjie,et al.Effect of Xingnaojing injection combined with sodium valproate in the treatment of post-stroke epilepsy[J].Journal of Xinxiang Medical University,2020,37(9):852.[doi:10.7683/xxyxyxb.2020.09.010]
[9]元芳芳,康　天,陈惠军,等.儿童注意缺陷多动障碍及其共患病临床分析[J].新乡医学院学报,2019,36(12):1152.[doi:10.7683/xxyxyxb.2019.12.012]
　YUAN Fang-fang,KANG Tian,CHEN Hui-jun,et al.Clinical analysis of attention deficit hyperactivity disorder and its comorbidity in children[J].Journal of Xinxiang Medical University,2019,36(9):1152.[doi:10.7683/xxyxyxb.2019.12.012]
[10]王　艳,张晓鑫,杨清成.丙戊酸钠和苯妥英钠联合治疗对难治性癫痫患者痫样放电及认知功能的影响[J].新乡医学院学报,2018,35(2):114.[doi:10.7683/xxyxyxb.2018.02.008]
　WANG Yan,ZHANG Xiao-xin,YANG Qing-cheng.Effect of sodium valproate combined with phenytoin sodium on the epileptiform discharge and cognitive function in patients with refractory epilepsy[J].Journal of Xinxiang Medical University,2018,35(9):114.[doi:10.7683/xxyxyxb.2018.02.008]

更新日期/Last Update: 2020-09-05