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儿童癫痫及抗癫痫药物对患儿骨密度和骨代谢的影响
作者:王丽丽  周九菊  张丽  牛建华  褚琳娜 
单位:沧州市人民医院 儿科, 河北 沧州 061000
关键词:癫痫 儿童 丙戊酸钠 左乙拉西坦 奥卡西平 骨密度 骨代谢 
分类号:R742.1
出版年·卷·期(页码):2019·47·第四期(421-427)
摘要:

目的:探讨儿童癫痫及抗癫痫药物对患儿骨密度(BMD)和骨代谢的影响。方法:(1)回顾性分析:选取我院收治的150例癫痫患儿,分为未治疗组50例、丙戊酸钠1组(VPA1组)35例、左乙拉西坦1组(LEV1组)33例、奥卡西平1组(OXC1组)32例,另选取50例在我院体检的正常儿童为对照组,分析癫痫和抗癫痫药物对儿童BMD及骨代谢的影响。(2)前瞻性研究:选取我院收治的学龄前期和学龄期癫痫患儿各100例,按照随机数字表法分别分为学龄前期的VPA2组33例、LEV2组34例、OXC2组33例及学龄期的VPA3组33例、LEV3组34例、OXC3组33例各3组。治疗3、6和12个月后,观察患儿BMD及骨代谢指标。结果:(1)回顾性研究:未治疗组BMD和钙离子水平比正常儿童低(P<0.05);VPA1组的BMD和钙离子水平比其它几组更低(P<0.05)。(2)前瞻性研究:学龄前期患儿治疗3、6及12个月后,VPA2组BMD和钙离子明显低于LEV2组及OXC2组(P<0.05),骨碱性磷酸酶(BAP)水平明显高于LEV2组和OXC2组(P<0.05);学龄期患儿治疗12个月后,VPA3组BMD和钙离子明显低于LEV3组及OXC3组(P<0.05),BAP水平明显高于LEV3组和OXC组3P<0.05)。结论:癫痫对患儿BMD及骨代谢影响显著;VPA对癫痫儿童BMD和骨代谢的影响随疗程的延长而增加;LEV和OXC对癫痫患儿的BMD和骨代谢没有明显影响,值得在临床推广应用。

Objective:To evaluate the influence of epilepsy and antiepileptic drugs on bone mineral density(BMD) and bone metabolism in children with epilepsy. Methods:A retrospective analysis was carried out on 150 children with epilepsy. The children were divided into untreated group(n=50), VPA1 group(n=35), LEV1 group(n=33) and OXC1 group(n=32). Fifty normal children were selected as control group. The influence of epilepsy itself and antiepileptic drugs on BMD and bone metabolism was retrospectively analyzed. A prospective study was carried out on 100 pre-school age and 100 school age epileptic children, who were randomly divided into three groups,i.e., 33 in VPA2 and VPA3 group,34 in LEV2 and LEV3 group, 33 in OXC2 and OXC3 group. After 3, 6 and 12 months, BMD and bone metabolism were observed. Results:In the retrospective study, there were statistically differences in BMD and calcium, of which the untreated group and other three groups were lower than those of normal children(P<0.05), and VPA group was the lowest. In the prospective study, after treatment in pre-school age children for 3, 6 and 12 months, there were statistically differences in BMD and calcium, of which VPA2 group was lower than those of LEV2 group and OXC2 group(P<0.05).And bone alkaline phosphatase(BAP) of VPA2 group was higher than those of LEV2 group and OXC2 group(P<0.05).After treatment in school age children for 12 months, there were statistically differences in BMD and calcium, of which the VPA3 group was lower than those of LEV3 group and OXC3 group(P<0.05). And BAP was higher than those of LEV3 group and OXC3 group(P<0.05). Conclusion:Epilepsy itself affects BMD and bone metabolism in children. The influences of VPA on BMD and bone metabolism are increased with the course of treatment. However, LEV and OXC have no significant effect on BMD and bone metabolism, which is worth promoting in clinical practice.

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