發(fā)布時(shí)間：2018-04-30 21:19

  本文選題：局灶性癲癇 + 抗癲癇藥物�。� 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景癲癇患者中,較大部分患者為局灶性癲癇。對(duì)于新診斷的局灶性癲癇患者來說,口服藥物治療是主要治療手段,單藥控制癲癇發(fā)作是首選治療方案,因此,藥物種類的選擇,尤其是初始藥物的選擇至關(guān)重要,可能會(huì)影響癲癇患者的預(yù)后。近十年來,隨著新型抗癲癇藥物在臨床上的廣泛使用,傳統(tǒng)抗癲癇藥物如丙戊酸和卡馬西平并沒有被完全取代。癲癇的藥物治療,尤其是局灶性癲癇的治療,是一個(gè)規(guī)范而長(zhǎng)期的過程,然而目前關(guān)于新型抗癲癇藥單藥治療局灶性癲癇的證據(jù)仍不充分,在新診斷癲癇患者的首選藥物上,新型抗癲癇藥物與傳統(tǒng)抗癲癇藥物比較并沒有絕對(duì)優(yōu)勢(shì),這有待進(jìn)一步研究。目的本研究比較五種常用抗癲癇藥物的有效性及不良反應(yīng),以期能指導(dǎo)日后臨床中局灶性癲癇患者的初始選藥。方法本研究以新鄉(xiāng)醫(yī)學(xué)院第二附屬醫(yī)院神經(jīng)內(nèi)科2006年1月至2014年11月期間開始用藥的局灶性癲癇患者為研究對(duì)象,由神經(jīng)內(nèi)科醫(yī)師綜合考慮患者情況分別應(yīng)用奧卡西平(OXC)、卡馬西平(CBZ)、拉莫三嗪(LTG)、丙戊酸鈉緩釋片(VPA)、托吡酯(TPM)單藥治療并進(jìn)行至少2年的隨訪研究。綜合多種指標(biāo)評(píng)價(jià)患者的療效、耐受性及不良反應(yīng),并對(duì)影響患者單藥保留的主要因素進(jìn)行分析。結(jié)果共有268例患者完成研究,分別為OXC組57例,CBZ組74例,LTG組44例,VPA組61例和TPM組32例。TPM組患者在開始服藥至第一次發(fā)作時(shí)間方面、2年內(nèi)持續(xù)無發(fā)作時(shí)間方面顯著優(yōu)于CBZ組及LTG組(P0.05)。不良反應(yīng)方面,OXC的不良反應(yīng)發(fā)生率顯著低于其余四組(P0.05),CBZ、TPM發(fā)生率顯著高于OXC、LTG、VPA(P0.05)。五組患者在有效率、無發(fā)作率、一年保留率、二年保留率方面比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。總體來說,未保留的主要原因?yàn)榀熜Р患?76.8%),其次為皮疹(12.5%)。結(jié)論五種藥物中,新型抗癲癇藥OXC表現(xiàn)出最佳的療效及耐受性。但在綜合指標(biāo)保留率方面,新型抗癲癇藥物OXC、LTG、TPM與傳統(tǒng)抗癲癇藥物VPA、CBZ相比并無優(yōu)勢(shì)。既往有腦部陽性病史、影像學(xué)異常、用藥前發(fā)作次數(shù)多(5)的患者,單藥保留失敗可能性大。
[Abstract]:Background among the patients with epilepsy, most of them are focal epilepsy. For newly diagnosed patients with focal epilepsy, oral drug therapy is the main treatment, and single drug control is the first choice of treatment. Therefore, the choice of drug type, especially the choice of initial drug, is very important. It may affect the prognosis of patients with epilepsy. In recent ten years, traditional antiepileptic drugs such as valproic acid and carbamazepine have not been completely replaced with new antiepileptic drugs. The drug therapy of epilepsy, especially the treatment of focal epilepsy, is a standard and long-term process. However, the evidence on the treatment of focal epilepsy with a new antiepileptic drug alone is still insufficient, and it is the first choice drug for newly diagnosed epileptic patients. There is no absolute superiority between new antiepileptic drugs and traditional antiepileptic drugs, which needs further study. Objective to compare the efficacy and adverse reactions of five commonly used antiepileptic drugs in order to guide the initial drug selection in patients with focal epilepsy. Methods the patients with focal epilepsy who were treated in Department of Neurology, second affiliated Hospital of Xinxiang Medical College, from January 2006 to November 2014, were studied. Patients were treated with oxacepine, carbamazepine (CBZ), lamotriazine (LTG), sodium valproate (VPAA), topiramate (TPM) respectively and followed up for at least 2 years. Objective: to evaluate the efficacy, tolerance and adverse reactions of patients by synthesizing various indexes, and to analyze the main factors that affect the retention of single drug in patients. Results A total of 268 patients completed the study. There were 57 cases in OXC group, 74 cases in LTG group and 61 cases in VPA group and 32 cases in TPM group, which were significantly better than those in CBZ group and LTG group in the time from the beginning to the first attack, the duration of no seizure within 2 years was significantly better than that in CBZ group and LTG group (P 0.05). The incidence of adverse reactions of OXC was significantly lower than that of the other four groups (P 0.05). The incidence of TPM was significantly higher than that of the other four groups (P 0.05). There was no significant difference in effective rate, no seizure rate, one year retention rate and two year retention rate among the five groups. On the whole, the main cause of unretained was poor curative effect 76. 8%, followed by rashes 12. 5%. Conclusion among the five drugs, the new antiepileptic drug OXC has the best efficacy and tolerance. But in the aspect of retention rate of comprehensive indexes, the TPM of new antiepileptic drug OXC+ LTGG has no advantage compared with the traditional antiepileptic drug VPA-CBZ. Patients with positive brain history, abnormal imaging, and more frequent episodes before medication were more likely to fail in single drug retention.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742.1

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