發(fā)布時間：2018-02-15 03:06

  本文關鍵詞： 丙戊酸 左乙拉西坦 學齡前期 學齡期 骨代謝　出處：《南方醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：癲癇是最常見的神經(jīng)系統(tǒng)疾病之一,據(jù)統(tǒng)計全世界約有五千萬人罹患癲癇。從上世紀出現(xiàn)抗癲癇藥物可影響患者骨代謝的報道以來,全球越來越多的神經(jīng)病學專家、學者開始重視抗癲癇藥物對骨代謝的不良反應。在我國,約有60%的癲癇患者起病于兒童期,同時兒童期的骨骼生長在人的一生中起著尤為重要的作用,因此探究抗癲癇藥對兒童骨代謝是否存在影響及其作用機制成為研究的重中之重。在可用于兒童的抗癲癇藥物中最常見的是丙戊酸鈉(valproate,VPA),卡馬西平(carbamazepine,CBZ),以及新型抗癲癇藥物奧卡西平(Oxc-arbazepine,0XC)、左乙拉西坦(levetiracetam,LEV)等。多數(shù)研究認為肝酶誘導型抗癲癇藥物主要是通過影響肝酶系統(tǒng)引起維生素D代謝增加進而導致代謝性骨病。近來,另有研究顯示非肝酶誘導的抗癲癇藥同樣可以引起骨代謝異常,然而其機制尚不清楚。因此,進一步探討非肝酶誘導劑型抗癲癇藥(丙戊酸、左乙拉西坦)對兒童骨代謝的影響是十分必要的。目的了解丙戊酸、左乙拉西坦單藥治療對學齡前期及學齡期兒童骨代謝的影響,探討其可能的機制。方法選擇學齡前期癲癇患兒39例,分別予單藥治療丙戊酸20例、左乙拉西坦19例;學齡期患兒40例,.分別予單藥治療丙戊酸21例、左乙拉西坦19例,作為觀察組;同時選擇正常體檢兒童41例,其中學齡前期21例、學齡期20例,作為對照組。分別記錄健康對照組及各觀察組治療前、治療3個月后、治療6個月后的血清鈣、磷、堿性磷酸酶(ALP)、25羥基維生素D[25-(OH)D]水平,并進行比較。結(jié)果丙戊酸和左乙拉西坦治療前的學齡前期及學齡期患兒的骨代謝水平與健康對照組均無顯著性差異(P0.05)。左乙拉西坦單藥治療的學齡前期和學齡期患兒其治療3個月后、6個月后的血清鈣、磷、ALP、25-(OH)D水平較治療前無明顯變化(P0.05);丙戊酸單藥治療學齡前期患兒其治療3個月后、6個月后的血清鈣、磷、ALP、25-(OH)D較治療前無明顯變化(P0.05);丙戊酸單藥治療6個月后的學齡期患兒的血清ALP較治療前升高(P0.05),鈣、磷、25-(OH)D較治療前差異不顯著(P0.05)。結(jié)論左乙拉西坦單藥治療對學齡前期及學齡期患兒骨代謝影響不大;丙戊酸單藥治療6個月內(nèi)即對學齡期兒童堿性磷酸酶產(chǎn)生影響。
[Abstract]:Epilepsy is one of the most common diseases of the nervous system. According to statistics, about 50 million people worldwide suffer from epilepsy. Since 0th century, there have been reports that antiepileptic drugs can affect bone metabolism in patients. Scholars have begun to attach importance to the adverse effects of antiepileptic drugs on bone metabolism. In China, about 60% of epileptic patients develop diseases in childhood, and the growth of bones in childhood plays a particularly important role in human life. The most common antiepileptic drugs used in children are valproate VPAA, carbamazepine carbamazepine (CBZ), and new antiepileptic drugs. Eclampsia drugs Oxc-arbazepine (Oxc-arbazepine), levoethoxetam (levetiracetaml) et al. Most studies suggest that liver enzyme inducible antiepileptic drugs increase vitamin D metabolism and lead to metabolic osteopathy by affecting the liver enzyme system. Other studies have shown that non-hepatic enzyme induced antiepileptic drugs can also cause abnormal bone metabolism, but its mechanism is not clear. Therefore, we further explore non-hepatic enzyme inducer type antiepileptic drugs (valproic acid, valproic acid, valproic acid, valproic acid, valproic acid, valproic acid). Objective to investigate the effect of valproic acid and levoethoxetam on bone metabolism in preschool and school-age children. Methods 39 children with pre-school epilepsy were treated with valproic acid (n = 20), levoethylacetam (n = 19), school-age children (n = 40), valproic acid (n = 21) and levoethoxetam (n = 19). As the observation group, 41 children with normal physical examination were selected as the control group. The serum calcium levels were recorded before treatment, 3 months after treatment and 6 months after treatment in the healthy control group and the observation group respectively, including 21 cases of pre-school age and 20 cases of school age. Phosphorous, alkaline phosphatase (ALP) 25 hydroxyvitamin D [25-OHH], Results there was no significant difference in bone metabolism between pre-school and school-age children with valproic acid and levoethoxetam compared with the control group (P 0.05). The preschool age and school age patients treated with levoethoxetam alone were not significantly different from those in the healthy control group (P < 0.05). After 3 months of treatment, 6 months of treatment of serum calcium, There was no significant change in the level of OHN D in ALPX 25-OHN group compared with that before treatment, and the serum calcium level in patients with pre-school children treated with valproic acid for 3 months and 6 months after treatment was similar to that of pre-school children, and there was no significant difference between the two groups before and after treatment. There was no significant change in serum ALP of children of school age after 6 months of valproic acid treatment, and the levels of serum ALP were higher than those before treatment. There was no significant difference between pre-treatment and pre-treatment. Conclusion Levoethylacetam alone has little effect on bone metabolism in preschool and school-age children, while valproic acid alone has an effect on alkaline phosphatase in school-age children within 6 months.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R742.1

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