摘要
目的 探究不同抗癫痫药物(AEDs)治疗卒中后癫痫(PSE)对血同型半胱氨酸(Hcy)水平的影响及叶酸(FA)、维生素B12(VitB_(12))的干预效果。方法 纳入2017年6月-2020年9月在南京市高淳人民医院诊治并规律接受AEDs治疗1年以上的PSE患者156例作为研究对象。按患者服药种类的不同将其分为单药治疗组丙戊酸钠(VPA)组34例、奥卡西平(OXC)组31例、左乙拉西坦(LEV)组29例、卡马西平(CBZ)组27例及联合用药组35例,另选同期新诊断未接受AEDs治疗的PSE患者35例作为对照组,测定并比较各组血Hcy水平,比较各组高同型半胱氨酸血症(Hhcy)发生率。随机选取其中的Hhcy患者40例进行FA及甲钴胺片补充治疗并记为干预组,比较干预组治疗前及治疗1、6个月后的血Hcy水平,另外未接受FA及VitB_(12)补充治疗的30例Hhcy患者保持原治疗方案不变并记为非干预组,治疗6个月后,比较干预组与非干预组的癫痫发作情况。结果 与对照组比较,VPA组、OXC组、CBZ组及联合用药组的血清Hcy水平均显著上升,VPA组及联合用药组的血清FA水平均有所下降,CBZ组及联合用药组的血清VitB_(12)水平均下降(P<0.05)。联合用药组的血清Hey水平显著高于LEV组(P<0.05)。VPA组、OXC组、CBZ组及联合用药组的HHcy发生率(41.18%、38.71%、44.44%、45.71%)均显著高于对照组(17.14%)(P<0.05)。干预组治疗1、6个月后的血Hcy水平均显著低于治疗前,且干预组治疗6个月后的血清Hcy水平均显著低于治疗1个月后,血清FA、VitB_(12)水平均显著高于治疗1个月后(P<0.05)。干预组的癫痫控制有效率(92.50%)显著高于非干预组(73.33%)(P<0.05)。结论 长期或多种的AEDs治疗可增加PSE患者罹患Hhcy的风险,并可对其血FA、VitB12水平产生不同程度的影响,对其予以新型的AEDs治疗,可在一定程度上减少AEDs治疗对血Hcy、FA、VitB_(12)水平的影响。此外,长期的FA及VitB_(12)补充治疗亦可有效改善其血Hcy水平并减少癫痫发作。
Objective To explore the effects of different antiepileptic drugs(AEDs)on blood homocysteine(Hcy)levels and the intervention effects of folic acid(FA)and vitamin B_(12)(VitB_(12))in patients with post-slroke epilepsy(PSE).Methods From June 2017 to September 2020,156 patients with PSE who were diagnosed and treated in our hospital and received regular AEDs for more than 1 year,patients were divided into the singledrug treatment group[the valproate(VPA)group(n=34),the oxcarbazepine(OXC)group(n=31),the levetiracetam(LEV)group(n=29),the carbamazepine(CBZ)group(n=27)]and the combined medication group(n=35).Another35 cases of PSE patients who were newly diagnosed and did not receive AEDs during the same period were selected as the control group.The blood Hey,FA,and VitB_(12)levels of each group were recorded.The incidence of hyperhomocysteinemia(Hhcy)of each group were compared.Among them,40 Hhcy patients were randomly selected for FA and VitB_(12)supplementary treatment and were recorded as the intervention group.The blood Hey,FA,and VitB,2 levels of the intervention group before treatment and 1,6 months after treatment were compared.In addition,30 Hhcy patients who did not receive FA and VitB_(12)supplementary treatment kept the original treatment plan unchanged and were recorded as the non-intervention group.After 6 months of treatment,the epileptic seizures of the intervention group and the non-intervention group were compared.Results Compared with the control group,the blood Hey level of the VPA group,OXC group,CBZ group and the combination medication group increased significantly,the blood FA level of the VPA group and the combination medication group decreased significantly,and the blood VitB_(12)level of the CBZ group and the combination medication group decreased significantly(P<0.05).The Hcy level of the combined medication group was significantly higher than that of the LEV group(P<0.05).The incidence of Hcy in the VPA group,OCX group,CBZ group and combination group(41.18%,38.71%,44.44%,45.71%)was significantly higher than that in the control group(17.14%)(P<0.05).The blood Hey level of the intervention group after 1 and 6 months of treatment was significantly lower than before treatment,the blood FA and VitB_(12)levels were significantly higher than before treatment,and the blood Hey level of the intervention group after 6 months of treatment was significantly lower than that after 1 month of treatment,the blood FA and VitB_(12)levels were significantly higher than after 1 month of treatment(P<0.05).The effective rate of epilepsy control in the intervention group(92.50%)was significantly higher than that of the non-intervention group(73.33%)(P<0.05).Conclusion Long-term or multiple AEDs treatment can increase the risk of Hhcy in PSE patients,and have varying influence on blood FA and VitB_(12)levels.Newly AEDs can reduce the influence of AEDs on blood Hey,FA and VitB_(12)levels to a certain extent.In addition,the Long-term FA and VitB_(12)supplementary treatment can effectively improve blood Hcy,FA and VitB,2 levels and reduce epileptic seizures.
作者
徐珊珊
王小姗
余传勇
郁媛文
王柳清
刘赞华
徐旭然
Xu Shanshan;Wang Xiaoshan;Yu Chuanyong;Yu Yuanwen;Wang Liuqing;Liu Zanhua;Xu Xuran(Department of Neurology,Nanjing Brain Hospital Affiliated to Nanjing Medical University,Jiangsu 210029,China)
出处
《脑与神经疾病杂志》
CAS
2023年第5期311-315,共5页
Journal of Brain and Nervous Diseases
基金
江苏省卫健委医学科研项目(22021079)
南京市级课题高淳人民医院高质量科研项目(GYK-2021-005)
江苏卫生健康职业学院级科研项目(JKB202007)。
