摘要
目的:探讨常用抗癫痫药物联合维生素B_(12)、叶酸对癫痫患儿血清同型半胱氨酸(Hcy)、血氨水平的影响。方法:选取河北省人民医院2015年1月至2018年2月收治的癫痫患儿270例,根据不同口服抗癫痫药物(AEDs)分为单纯奥卡西平组65例,单纯丙戊酸钠组65例,奥卡西平联合维生素B_(12)/叶酸组70例,丙戊酸钠联合维生素B_(12)/叶酸组70例。干预3个月后,检测患儿血清Hcy、血氨、维生素B_(12)、叶酸水平。观察治疗前后患儿生活质量,焦虑、抑郁、负面情绪等改善效果,随访1年统计复发率和复发时间。结果:治疗后,奥卡西平联合维生素B_(12)/叶酸组和丙戊酸钠联合维生素B_(12)/叶酸组总有效率分别为94.3%和92.9%,高于单纯奥卡西平组和单纯丙戊酸钠组(P<0.05)。治疗后,奥卡西平联合维生素B_(12)/叶酸组、丙戊酸钠联合维生素B_(12)/叶酸组高血清Hcy、高血氨的比例低于单纯奥卡西平组、单纯丙戊酸钠组(P<0.05),奥卡西平联合维生素B_(12)/叶酸组和丙戊酸钠联合维生素B_(12)/叶酸组以及单纯奥卡西平组和单纯丙戊酸钠组组间Hcy、血氨水平比较差异无统计学意义(P>0.05)。四组治疗前后脑电图δ波、θ波、ɑ波、β波各频段占比组内、组间比较差异均无统计学意义(P>0.05)。奥卡西平联合维生素B_(12)/叶酸组、丙戊酸钠联合维生素B_(12)/叶酸组治疗后生活质量量表-31(QOLIE-31)评分高于单纯奥卡西平组、单纯丙戊酸钠组,汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分低于单纯奥卡西平组、单纯丙戊酸钠组(P<0.05)。治疗后随访1年,奥卡西平联合维生素B_(12)/叶酸组、丙戊酸钠联合维生素B_(12)/叶酸组癫痫复发率、复发时间均低于或短于单纯奥卡西平组、单纯丙戊酸钠组(P<0.05)。结论:抗癫痫药物联合补充维生素B_(12)和叶酸治疗癫痫患儿可降低患儿血清Hcy、血氨水平,提高治疗效果,改善脑电图状况,提高生活质量,缓解心理不良情绪,且不会增加不良反应。
Objective: To probe into the effects of common antiepileptic drugs combined with vitamin B_(12)and folic acid on serum homocysteine(Hcy) and blood ammonia levels in children with epilepsy. Methods: A total of 270 children with epilepsy admitted into Hebei General Hospital from Jan. 2015 to Feb. 2018 were selected. According to different oral antiepileptic drugs(AEDs), all patients were divided into 65 cases in the single oxcarbazepine group, 65 cases in the single sodium valproate group, 70 cases in the oxcarbazepine combined with vitamin B_(12)/folic acid group, and 70 cases in the sodium valproate combined with vitamin B_(12)/folic acid group. After 3 months of intervention, serum Hcy, blood ammonia, vitamin B_(12)and folic acid levels were detected. The quality of life, anxiety, depression and negative emotions of the children before and after treatment were observed, and the recurrence rate and recurrence time were counted in the follow-up for 1 year. Results: After treatment, the total effective rates of oxcarbazepine combined with vitamin B_(12)/folic acid group and sodium valproate combined with vitamin B_(12)/folic acid group were respectively 94.3% and 92.9%, higher than those of the single oxcarbazepine group and single sodium valproate group(P<0.05). After treatment, the proportions of high serum Hcy and high blood ammonia in oxcarbazepine combined with vitamin B_(12)/folic acid group and sodium valproate combined with vitamin B_(12)/folic acid group were lower than those in single oxcarbazepine group and single sodium valproate group(P<0.05). There were no significant differences in Hcy and blood ammonia levels between the oxcarbazepine combined with vitamin B_(12)/folic acid group and sodium valproate combined with vitamin B_(12)/folic acid group, and between the single oxcarbazepine group and single sodium valproate group(P>0.05). There was no significant difference in the proportion of δ wave, θ wave, ɑ wave and β wave in EEG before and after treatment(P>0.05). After treatment, the quality of life in epilepsy inventory-31(QOLIE-31) scores in the oxcarbazepine combined with vitamin B_(12)/folic acid group and sodium valproate combined with vitamin B_(12)/folic acid group were higher than those in the single oxcarbazepine group and single sodium valproate group, Hamilton anxiety scale(HAMA) and Hamilton depression scale(HAMD) scores were lower than those of the single oxcarbazepine group and single sodium valproate group(P<0.05). The recurrence rate and recurrence time of oxcarbazepine combined with vitamin B_(12)/folic acid group and sodium valproate combined with vitamin B_(12)/folic acid group were lower or shorter than those of the single oxcarbazepine group and single sodium valproate group(P<0.05). Conclusion: Antiepileptic drugs combined with vitamin B_(12)and folic acid supplementation can reduce the serum Hcy and blood ammonia levels in children with epilepsy, promote the treatment effects, improve the electroencephalogram and the quality of life, relief the psychological mood, without increasing the incidence of adverse drug reactions.
作者
孙萌
王鑫
周冉
郑有宁
程亚颖
Sun Meng;Wang Xin;Zhou Ran;Zheng Youning;Cheng Yaying(Hebei General Hospital,Shijiazhuang 050051,China)
出处
《儿科药学杂志》
CAS
2022年第4期32-37,共6页
Journal of Pediatric Pharmacy
基金
河北省卫生计生委重点课题计划项目,编号20170256。
