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3种一线抗癫痫药物对儿童骨代谢及生活质量的影响
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:抗癫痫药物 骨代谢 骨密度异常 生活质量 神经认知 儿童 
分类号:R971.6
出版年·卷·期(页码):2020·39·第三期(334-339)
摘要:

目的:探究丙戊酸钠、左乙拉西坦及奥卡西平对儿童骨代谢及生活质量的影响。方法:选取2016年1月至2017年6月在沧州市人民医院儿科初诊癫痫并应用单药治疗的95例患儿,根据使用药物的不同分为VPA组(丙戊酸钠)、LEV组(左乙拉西坦)和OXC组(奥卡西平)。对比3组治疗前后血清钙、磷、碱性磷酸酶、25-(OH)D及骨密度的变化;统计并对比骨密度异常的发生情况;使用语言智商量表(verbal IQ,VIQ)、操作智商量表(performance IQ,PIQ)以及总智商量表(full scale IQ,FIQ)评估治疗前后患儿神经认知情况;统计并对比3组治疗不良反应发生情况。结果:VPA组治疗1年后血钙较治疗前显著下降(t=3.092,P=0.003),血磷显著升高(t=-4.939,P<0.001),碱性磷酸酶治疗后呈进行性升高(P<0.05),25-(OH)D及骨密度呈进行性降低(P<0.05);VPA组骨密度异常发生率显著高于LEV组及OXC组(Log rank χ2值分别为8.568、7.430,P值分别为0.003、0.006);治疗1年后,VPA组PIQ显著下降(t=18.348,P<0.001);LEV组3个量表评分均显著提高(P<0.05)。结论:左乙拉西坦治疗癫痫时对患儿骨代谢影响较少,同时能有效提高患儿神经认知能力,增强其生活质量。

Objective: To explore the effect of valproic acid, levetiracetam, oxcarbazepine on bone metabolism and quality of life in children.Methods: From January 2016 to June 2017,95 children with epileptic in Department of Pediatric,Cangzhou People's Hospital,were retrospectively analyzed,and were divided into VPA group, LEV group and OXC group according to antiepileptic drugs used, the three groups received treatment of valproic acid, levetiracetam, oxcarbazepine. Calcium, phosphorus, alkaline phosphatase, 25-(OH)D in serum and bone density of the three groups were compared before and after treatment, the occurrence of abnormal bone density was statistically and compared, usingverbal IQ(VIQ), performance IQ(PIQ),full scale IQ(FIQ) to evaluate the patients's neurocognitive status before and after treatment, the incidence of adverse reactions during the follow-up were statistically analyzed.Results: Serum calcium in VPA group decreased significantly after 1 year of treatment compared with before treatment(t=3.092,P=0.003), serum phosphorus in VPA group increased significantly after 1 year of treatment compared with before treatment(t=-4.939,P<0.001), alkaline phosphatase showed progressive increase after treatment(P<0.05), 25-(OH)Dand bone density decreased progressively after treatment(P<0.05).The incidence of abnormal bone densityin VPA group was significantly higher than that in the other two groups(Log rank χ2=8.568,7.430;P=0.003,0.006), the PIQ in VPA group was significantly decreased 1 year after treatment(t=18.348,P<0.001), the score of VIQ, PIQ, FIQ in LEV group were significantly increased 1 year after treatment(P<0.05). Conclusion: Levetiracetam has less effect on bone metabolism in children with epilepsy, it can also effectively improve neurocognitive ability quality of life.

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