抗癫痫药物对学龄期癫痫儿童情绪行为影响的研究

发布时间：2018-06-23 10:15

本文选题：癫痫 + 儿童　；参考：《青岛大学》2017年硕士论文

【摘要】：目的研究服用单种抗癫痫药物进行治疗的癫痫儿童存在的情绪行为问题,并分析常见的抗癫痫药物对情绪行为造成的不同影响,从而更好地指导抗癫痫药物的选用。方法收集2014年9月-2016年6月于我院儿科门诊和病房就诊的服用托吡酯(TPM)、丙戊酸钠(VPA)、左乙拉西坦(LEV)进行单药治疗的原发性癫痫患儿作为病例组,同时收集期间新诊断为癫痫但尚未开始治疗的患儿和健康儿童作为对照组,对其使用Achenbach儿童行为量表(CBCL,家长用)进行情绪行为问题的评定。通过单因素方差分析和Kruskal-Wallis检验比较各组癫痫儿童的一般情况、异常行为发生率、各因子得分和CBCL总得分。结果(1)癫痫儿童行为异常的总检出率为7.7%,各组的检出率比较:LEV组(11.5%)TPM组(9.1%)新发未服药组(7.1%)VPA组(3.4%)健康儿童(0),但各组间的差异无统计学意义(χ~2=1.344,P0.05)。男性患儿行为异常检出率(9.1%)高于女性患儿(2.3%),但差异无统计学意义(χ~2=1.873,P0.05)。(2)CBCL量表按四个不同性别年龄段(6-11岁男性及女性,12-16岁男性及女性)对各组的情绪行为因子的得分进行比较,结果显示:(1)6-11岁男性癫痫患儿,在分裂样、强迫性方面:LEV组VPA组TPM组新发组健康组;在体诉、违纪方面:TPM组VPA组LEV组新发组健康组;在抑郁、交往不良、社交退缩、多动、攻击性、CBCL总分方面:TPM组LEV组VPA组新发组健康组。具有显著统计学差异(P0.05)的为多动:TPM组明显高于VPA组、新发未服药组、健康组;抑郁方面,TPM明显高于新发未服药组、健康组;攻击性方面,TPM、VPA明显高于新发未服药组、健康组;CBCL总分上,TPM组明显高于新发未服药组。(2)6-11岁女性癫痫患儿,在抑郁、体诉方面的得分比较:LEV组TPM组VPA组新发组健康组;社交退缩、多动、攻击性、总分方面:TPM组LEV组VPA组新发组健康组;分裂强迫:TPM组LEV组新发组VPA组健康组;具有显著统计学差异(P0.05)的两两比较结果如下:抑郁方面,TPM组、LEV组明显高于VPA组、新发组、健康组;多动方面,TPM组明显高于VPA组、新发未服药组、健康组,LEV组明显高于新发未服药组;攻击性方面,TPM组、LEV组明显高于新发未服药组、健康组;CBCL总分上,TPM组明显高于VPA组、新发组、健康组,LEV组明显高于新发未服药组、健康组。(3)12-16岁的男性癫痫患儿,在体诉方面的得分比较:VPA组新发组TPM组LEV组健康组;分裂样、交往不良、强迫性、违纪、攻击性、CBCL总分方面:TPM组VPA组LEV组新发组健康组,其中TPM组交往不良的总分显著高于健康组(P0.05)。不成熟方面:VPA组LEV组TPM组健康组新发组;敌意性:LEV组TPM组VPA组新发组健康组;多动:VPA组LEV组TPM组新发组健康组,其中TPM组交往不良的总分显著高于健康组。(4)12-16岁女性癫痫患儿,焦虑强迫、抑郁退缩、CBCL总分方面的得分比较:LEV组VPA组新发组健康组;体诉、分裂样、不成熟方面:VPA组LEV组新发组≥健康组;违纪:LEV组新发组VPA组、健康组,各因子及CBCL总分之间的差别均无统计学意义(P0.05)。结论(1)服用托吡酯单药治疗的6-11岁癫痫儿童较服用左乙拉西坦、丙戊酸更易出现多动、社交退缩、违纪、攻击等情绪行为问题;而12-16岁癫痫男性患儿的情绪行为问题发生率相对降低,主要表现为分裂样、交往不良、强迫性、违纪、攻击性等。(2)服用左乙拉西坦单药治疗的6-11岁癫痫儿童情绪行为问题的发生率低于托吡酯组,但男性患儿的分裂样、强迫性及女性患儿的抑郁、体诉发生率高于托吡酯、丙戊酸钠组。12-16岁的癫痫儿童发生率相对降低,主要表现为敌意性、焦虑强迫、抑郁退缩、攻击性等。(3)服用丙戊酸钠单药治疗的6-11岁癫痫儿童的出现情绪行为问题的可能性较小,相对多见的有分裂样、强迫性、体诉、违纪等;但12-16岁年龄组的发生率相对增加,主要表现为不成熟、体诉、多动、分裂样等。(4)不同性别的癫痫儿童其情绪行为问题的发生率无明显差异。
[Abstract]:Objective to study the emotional and behavioral problems of epileptic children treated with single antiepileptic drugs, and to analyze the different effects of common antiepileptic drugs on emotional behavior, so as to better guide the selection of antiepileptic drugs. Methods to collect topiramate in the outpatient department of Pediatrics and ward of our hospital in September 2014, -2016 years, in June. (TPM) a single drug treatment of primary epilepsy in children with sodium valproate (VPA) and levetiracetam (LEV) as a case group. At the same time, children and healthy children who were newly diagnosed with epilepsy but have not yet been treated as the control group were used to evaluate their emotional behavior problems with the Achenbach children's behavior scale (CBCL, parents). Factor variance analysis and Kruskal-Wallis test were used to compare the general situation of epileptic children, the incidence of abnormal behavior, the score of each factor and the total CBCL score. Results (1) the total detection rate of abnormal behavior in epileptic children was 7.7%, and the detection rates of each group were compared: group LEV (11.5%) TPM (9.1%) new untreated group (7.1%) VPA group (3.4%) healthy children (0), but each of them (0) There was no statistical difference between groups (x ~2=1.344, P0.05). The rate of abnormal behavior in male children (9.1%) was higher than that of female children (2.3%), but the difference was not statistically significant (x ~2=1.873, P0.05). (2) the CBCL scale was based on four different sex and age groups (6-11 years old male and female, 12-16 year old male and female) for the scores of emotional and behavioral factors in each group. Comparison, the results were as follows: (1) the 6-11 year old male epileptic children, in the division like, compulsive aspects: group LEV VPA group TPM new hair group health group; in body complaints, violation of discipline: TPM group VPA group LEV group health group; in depression, bad communication, social withdrawal, hyperactivity, aggression, CBCL total score: TPM group LEV group VPA group new hair group health group. With significant integration group. Study difference (P0.05) for hyperactivity: TPM group was significantly higher than group VPA, new untreated group, health group, and depression, TPM was significantly higher than the new untreated group, healthy group, TPM, VPA were significantly higher than the new untreated group, healthy group; CBCL total score, TPM group was significantly higher than the new untreated group. (2) 6-11 year old female epileptic children, depression, The scores of body complaints were compared: LEV group TPM group VPA group new hair group health group; social withdrawal, hyperactivity, aggression, total score: TPM group LEV group VPA group healthy group; division compulsion: TPM group LEV group new group VPA group healthy group; the significant statistical difference (P0.05) 22 comparison results are as follows: depression, TPM group, LEV group obviously higher than those Group, new hair group, health group, group TPM was obviously higher than group VPA, new untreated group, healthy group, group LEV were obviously higher than that of new untreated group; attack, group TPM, LEV group were obviously higher than that of new untreated group, healthy group; CBCL total score, TPM group was obviously higher than group VPA, new hair group, health group, LEV group was obviously higher than that of new untreated group, healthy group, healthy group. (3) 12-16 year old male epileptic children, the scores of body complaints were compared: group VPA new hair group TPM group LEV health group; split like, bad communication, compulsion, discipline, aggression, CBCL total score: TPM group VPA group LEV group new hair group health group, TPM group malfunction total score is significantly higher than the healthy group (P0.05). Immature aspect: VPA LEV LEV Group TPM healthy group Xin hair group; hostility: group LEV TPM group VPA group new hair group health group; hyperactivity: VPA group LEV group TPM group new hair group health group, among which TPM group malfunction total score was significantly higher than the healthy group. (4) the 12-16 year old female epileptic children, anxiety compulsion, depression and withdrawal, CBCL total score: LEV group VPA group health group; body complaint VPA group, group LEV, group VPA, health group, health group, and CBCL total score were not statistically significant (P0.05). Conclusion (1) 6-11 year old epileptic children taking topiramate as a single drug treated with levetiracetam, valproic acid is more likely to appear hyperactivity, social withdrawal, violation, The incidence of emotional behavior in the 12-16 year old epileptic male children was lower than that of the topiramate group. (2) the incidence of emotional and behavioral problems of 6-11 year old epileptic children treated with levetiracetam was lower than that in the topiramate group, but the schizophrenia in the male children was divided. The incidence of body complaints was higher than that of topiramate. The incidence of epileptic children aged.12-16 years old in the sodium valproate group was relatively lower, mainly manifested by hostility, anxiety, depression and aggression. (3) the possibility of emotional behavior problems of 6-11 year old epileptic children treated with sodium valproate single drug was less likely. The incidence of 12-16 year old age group was relatively increased, mainly manifested by immature, body complaints, hyperactivity, splits and so on. (4) there was no significant difference in the incidence of emotional and behavioral problems between different sex epileptic children.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1

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