左乙拉西坦治疗妊娠期癫痫疗效及胎儿安全性的Meta分析

发布时间：2018-05-29 10:18

本文选题：左乙拉西坦 + 妊娠期　；参考：《中国医院药学杂志》2017年01期

【摘要】：目的:评价左乙拉西坦治疗妊娠期癫痫的疗效及其对胎儿的影响。方法:计算机检索Medline、Cochrane library、EMbase、CNKI、万方、维普、CBM数据库,收集有关左乙拉西坦治疗妊娠期癫痫疗效及胎儿安全性的队列研究和病例对照研究。依据纽卡斯-渥太华量表(NOS量表)对符合纳入标准的临床研究进行质量评价,并采用RevMan5.3进行Meta分析。结果:本研究共纳入11篇队列研究进行分析,采用NOS评分评估偏移风险,其中10项研究的得分均在7~9分。Meta分析结果显示,在妊娠期癫痫发作控制率方面,左乙拉西坦组低于丙戊酸钠组,差异有统计学意义(P0.05);而左乙拉西坦与拉莫三嗪、托吡酯、卡马西平或苯妥因单药治疗相比,两组间差异均无统计学意义(P0.05)。在新生儿严重先天畸形发生率方面,左乙拉西坦组低于拉莫三嗪、托吡酯、丙戊酸钠、卡马西平或苯巴比妥组,差异均有统计学意义(P0.05);左乙拉西坦组与奥卡西平组相比,两组间差异无统计学意义(P0.05);左乙拉西坦单药治疗组明显低于多药治疗组(P0.05)。左乙拉西坦对宫内死胎发生率的影响与拉莫三嗪、丙戊酸钠、卡马西平无明显区别(P0.05)。结论:妊娠期癫痫患者服用左乙拉西坦单药治疗,其癫痫控制率可能低于丙戊酸钠,但与拉莫三嗪、托吡酯、卡马西平及苯妥因单药治疗疗效大致相当。在胎儿安全性结局方面,左乙拉西坦致畸性可能优于拉莫三嗪、托吡酯、丙戊酸钠、卡马西平及苯巴比妥,合并使用其他抗癫痫药物增加其致畸风险;左乙拉西坦对宫内死胎发生率的影响与拉莫三嗪、丙戊酸钠、卡马西平无明显区别。本文纳入研究均为队列研究,易受偏移风险的影响,故存在一定局限性。
[Abstract]:Objective: to evaluate the efficacy of levoethylacetam in the treatment of pregnancy epilepsy and its influence on fetus. Methods: Medlinea Cochrane libraryEMbase CNKI, Wanfang, Vipric CBM database were searched, and cohort studies and case-control studies on the efficacy and safety of levoethylacetam in the treatment of pregnancy epilepsy were collected. According to the Neucas-Ottawa scale, the quality of the clinical study was evaluated according to the inclusion criteria, and the Meta analysis was performed by RevMan5.3. Results: a total of 11 cohort studies were included in this study, and NOS scores were used to assess the risk of deviation. The scores of 10 studies ranged from 7 to 9. The results of meta-analysis showed that the control rate of epileptic seizures during pregnancy was significant. There was no significant difference between levoethoxetam group and lamotriazine, topiramate, carbamazepine or phentone group (P 0.05). In the incidence of severe congenital malformation in neonates, the incidence of severe congenital malformations in levoethylacetam group was lower than that in lamotriazine group, topiramate group, valproate sodium group, carbamazepine group or phenobarbital group. The difference between the two groups was not statistically significant (P 0.05), but that in the single drug group was significantly lower than that in the multidrug treatment group (P 0.05). There was no significant difference between levoethylacetam and lamotriazine sodium valproate and carbamazepine in the incidence of intrauterine stillbirth. Conclusion: the epileptic control rate of patients with pregnancy epilepsy may be lower than that of sodium valproate, but it is similar to that of lamotriazine, topiramate, carbamazepine and phentoin. The teratogenicity of levoethoxetam may be superior to that of lamotriazine, topiramate, sodium valproate, carbamazepine and phenobarbital. The effect of levoethylacetam on intrauterine fetal death was not significantly different from that of lamotrigine, valproate and carbamazepine. All the studies included in this paper are cohort studies, which are easily affected by the risk of migration, so there are some limitations.
【作者单位】：北京大学人民医院药剂科;
【基金】：国家自然科学基金资助项目(编号:81200887,81503050)
【分类号】：R742.1;R714.2

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