丙戊酸、左乙拉西坦对学龄前期及学龄期儿童骨代谢的影响

发布时间：2018-02-15 03:06

本文关键词： 丙戊酸左乙拉西坦学龄前期学龄期骨代谢　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：癫痫是最常见的神经系统疾病之一,据统计全世界约有五千万人罹患癫痫。从上世纪出现抗癫痫药物可影响患者骨代谢的报道以来,全球越来越多的神经病学专家、学者开始重视抗癫痫药物对骨代谢的不良反应。在我国,约有60%的癫痫患者起病于儿童期,同时儿童期的骨骼生长在人的一生中起着尤为重要的作用,因此探究抗癫痫药对儿童骨代谢是否存在影响及其作用机制成为研究的重中之重。在可用于儿童的抗癫痫药物中最常见的是丙戊酸钠(valproate,VPA),卡马西平(carbamazepine,CBZ),以及新型抗癫痫药物奥卡西平(Oxc-arbazepine,0XC)、左乙拉西坦(levetiracetam,LEV)等。多数研究认为肝酶诱导型抗癫痫药物主要是通过影响肝酶系统引起维生素D代谢增加进而导致代谢性骨病。近来,另有研究显示非肝酶诱导的抗癫痫药同样可以引起骨代谢异常,然而其机制尚不清楚。因此,进一步探讨非肝酶诱导剂型抗癫痫药(丙戊酸、左乙拉西坦)对儿童骨代谢的影响是十分必要的。目的了解丙戊酸、左乙拉西坦单药治疗对学龄前期及学龄期儿童骨代谢的影响,探讨其可能的机制。方法选择学龄前期癫痫患儿39例,分别予单药治疗丙戊酸20例、左乙拉西坦19例;学龄期患儿40例,.分别予单药治疗丙戊酸21例、左乙拉西坦19例,作为观察组;同时选择正常体检儿童41例,其中学龄前期21例、学龄期20例,作为对照组。分别记录健康对照组及各观察组治疗前、治疗3个月后、治疗6个月后的血清钙、磷、碱性磷酸酶(ALP)、25羟基维生素D[25-(OH)D]水平,并进行比较。结果丙戊酸和左乙拉西坦治疗前的学龄前期及学龄期患儿的骨代谢水平与健康对照组均无显著性差异(P0.05)。左乙拉西坦单药治疗的学龄前期和学龄期患儿其治疗3个月后、6个月后的血清钙、磷、ALP、25-(OH)D水平较治疗前无明显变化(P0.05);丙戊酸单药治疗学龄前期患儿其治疗3个月后、6个月后的血清钙、磷、ALP、25-(OH)D较治疗前无明显变化(P0.05);丙戊酸单药治疗6个月后的学龄期患儿的血清ALP较治疗前升高(P0.05),钙、磷、25-(OH)D较治疗前差异不显著(P0.05)。结论左乙拉西坦单药治疗对学龄前期及学龄期患儿骨代谢影响不大;丙戊酸单药治疗6个月内即对学龄期儿童碱性磷酸酶产生影响。
[Abstract]:Epilepsy is one of the most common diseases of the nervous system. According to statistics, about 50 million people worldwide suffer from epilepsy. Since 0th century, there have been reports that antiepileptic drugs can affect bone metabolism in patients. Scholars have begun to attach importance to the adverse effects of antiepileptic drugs on bone metabolism. In China, about 60% of epileptic patients develop diseases in childhood, and the growth of bones in childhood plays a particularly important role in human life. The most common antiepileptic drugs used in children are valproate VPAA, carbamazepine carbamazepine (CBZ), and new antiepileptic drugs. Eclampsia drugs Oxc-arbazepine (Oxc-arbazepine), levoethoxetam (levetiracetaml) et al. Most studies suggest that liver enzyme inducible antiepileptic drugs increase vitamin D metabolism and lead to metabolic osteopathy by affecting the liver enzyme system. Other studies have shown that non-hepatic enzyme induced antiepileptic drugs can also cause abnormal bone metabolism, but its mechanism is not clear. Therefore, we further explore non-hepatic enzyme inducer type antiepileptic drugs (valproic acid, valproic acid, valproic acid, valproic acid, valproic acid, valproic acid). Objective to investigate the effect of valproic acid and levoethoxetam on bone metabolism in preschool and school-age children. Methods 39 children with pre-school epilepsy were treated with valproic acid (n = 20), levoethylacetam (n = 19), school-age children (n = 40), valproic acid (n = 21) and levoethoxetam (n = 19). As the observation group, 41 children with normal physical examination were selected as the control group. The serum calcium levels were recorded before treatment, 3 months after treatment and 6 months after treatment in the healthy control group and the observation group respectively, including 21 cases of pre-school age and 20 cases of school age. Phosphorous, alkaline phosphatase (ALP) 25 hydroxyvitamin D [25-OHH], Results there was no significant difference in bone metabolism between pre-school and school-age children with valproic acid and levoethoxetam compared with the control group (P 0.05). The preschool age and school age patients treated with levoethoxetam alone were not significantly different from those in the healthy control group (P < 0.05). After 3 months of treatment, 6 months of treatment of serum calcium, There was no significant change in the level of OHN D in ALPX 25-OHN group compared with that before treatment, and the serum calcium level in patients with pre-school children treated with valproic acid for 3 months and 6 months after treatment was similar to that of pre-school children, and there was no significant difference between the two groups before and after treatment. There was no significant change in serum ALP of children of school age after 6 months of valproic acid treatment, and the levels of serum ALP were higher than those before treatment. There was no significant difference between pre-treatment and pre-treatment. Conclusion Levoethylacetam alone has little effect on bone metabolism in preschool and school-age children, while valproic acid alone has an effect on alkaline phosphatase in school-age children within 6 months.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1

【参考文献】