抗癫痫药物对卒中后癫痫患者血清同型半胱氨酸、叶酸、B族维生素水平的影响

发布时间：2018-03-13 18:30

本文选题：卒中后癫痫　切入点：抗癫痫药物　出处：《临床神经病学杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的探讨4种常用抗癫痫药物(AEDs)对卒中后癫痫(PSE)患者血清同型半胱氨酸(Hcy)、叶酸、维生素B_(12)、维生素B_6水平的影响。方法对规则口服AEDs 1年以上的194例PSE患者(AEDs治疗组)及新诊断未服药的40例PSE患者(对照组)进行血清Hcy、叶酸、维生素B_(12)、维生素B_6水平检测。探讨不同AEDs对患者上述指标的影响。结果与对照组相比,AEDs治疗组血清Hcy水平明显增高,血清叶酸、维生素B_(12)水平明显降低(均P0.05)。各组间血清维生素B_6水平的差异无统计学意义。与单药治疗亚组比较,联合用药亚组血清Hcy水平明显升高(P0.05)。与对照组相比,采用丙戊酸钠(VPA)、卡马西平(CBZ)、奥卡西平(OXC)单药治疗的患者血清Hcy水平显著增加,采用VPA、CBZ单药治疗的患者血清叶酸水平明显降低,采用VPA单药治疗的患者血清维生素B_(12)水平明显降低(均P0.05)。与对照组相比,采用VPA+CBZ、VPA+左乙拉西坦(LEV)、VPA+OXC、CBZ+LEV双药联合治疗及≥3种AEDs联合治疗的患者血清Hcy水平显著增加,采用VPA+LEV、VPA+OXC、CBZ+LEV双药联合治疗及≥3种AEDs联合治疗的患者血清叶酸水平明显降低,采用VPA+CBZ、VPA+OXC、CBZ+LEV双药联合治疗及≥3种AEDs联合治疗的患者血清维生素B_(12)水平明显降低(均P0.05)。AEDs治疗组高Hcy血症(HHcy)发生率(36.6%)明显高于对照组(20.0%)(χ~2=4.085,P=0.043)。其中联合用药亚组HHcy发生率(47.6%)与对照组比较差异有统计学意义(χ~2=6.950,P=0.008);单药治疗亚组HHcy发生率(33.6%)与对照组比较差异无统计学意义。VPA、CBZ单药治疗的患者HHcy发生率(40.5%;43.8%)明显高于对照组(χ~2=3.871,P=0.049;χ~2=4.726,P=0.030)。OXC、LEV单药治疗的患者HHcy发生率(29.2%;22.9%)与对照组比较差异无统计学意义。结论AEDs治疗对PSE患者血清维生素B_6水平的影响不大,但对其血清Hcy、叶酸、维生素B_(12)水平影响较大。联合应用AEDs或VPA、CBZ单药治疗可能增加PSE患者HHcy的发生率。
[Abstract]:Objective to investigate the effects of four common antiepileptic drugs (AEDs) on serum homocysteine (Hcy) and folic acid (folic acid) in patients with post-stroke epilepsy (PSEs). Methods Serum Hcyand folic acid were given to 194 patients with AEDs who had been treated regularly for more than one year with PSE and 40 newly diagnosed patients with PSE (control group). The effects of different AEDs on the above indexes were investigated. Results compared with the control group, the serum Hcy level and serum folic acid were significantly increased in the AEDs treatment group. There was no significant difference in serum vitamin B6 levels between the two groups. Compared with the single drug treatment subgroup, the serum Hcy level in the combined treatment subgroup was significantly higher than that in the control group. The serum Hcy level of the patients treated with sodium valproate, carbamazepine and oxacillin was significantly increased, while the serum folic acid level of the patients treated with VPA-CBZ was significantly decreased. The serum vitamin B level of patients treated with VPA was significantly lower than that of control group (all P 0.05). Compared with the control group, the serum Hcy level of patients treated with VPA CBZG / VPA-VPA-levoxetanolacetanolacetanolactam / VPA / VPA-OXCZ / CBZ / LEV or more than 3 kinds of AEDs was significantly higher than that of the control group (P < 0. 05, P < 0. 05). The serum folic acid level was significantly decreased in patients treated with VPA Levo VPA oxCX LEV combined with two drugs or more than 3 kinds of AEDs. The serum vitamin B level of patients treated with VPA CBZ + VPA oxCX CBZ LEV or more than 3 kinds of AEDs was significantly lower than that of the control group (P 0.05 + .AEDs treatment group), and the incidence of hyper#en3# Hcy was significantly higher than that of the control group (蠂 24.085% P0.043 3). HHcy was found in the combined subgroup (P < 0.05), especially in the control group (P < 0.05. 05%, P < 0.05), and the incidence of HHcy in the treatment group was significantly higher than that in the control group (蠂 2 4.08 5%, P < 0.043 3). There was no significant difference in the incidence of HHcy between the control group and the control group (蠂 26.950 P0. 008; the incidence of HHcy in the single drug subgroup was 33. 6). There was no significant difference in the incidence of HHcy between the two groups. The incidence of HHcy in the single drug treated group was significantly higher than that in the control group (蠂 2. 871 P0. 049; 蠂 2 + 24. 726 P0. 030. 0. 030% OXCLEV monotherapy). The incidence of HHcy in the control group was significantly higher than that in the control group (蠂 2. 871, P 0.049; 蠂 2, 24. 726, P 0.030, P 0. 030, P 0. 030, P 0. 030). There was no significant difference between the incidence of HHcy and the control group. Conclusion the effect of AEDs treatment on serum vitamin B6 level in PSE patients was not significant. However, the serum levels of Hcy, folic acid and vitamin B were significantly affected. Combined use of AEDs or VPA CBZ alone may increase the incidence of HHcy in patients with PSE.
【作者单位】：苏州大学附属第二医院神经内科;
【基金】：苏州市科技发展计划(应用基础)(SYS201549)
【分类号】：R742.1;R743.3

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