左乙拉西坦及奥卡西平对癫痫患儿丙戊酸钠及其代谢产物2-丙基-2-戊烯酸血药浓度的影响

目的:探讨左乙拉西坦(Levetiracetam,LEV)、奥卡西平(Oxcarbazepine,OXC)对丙戊酸钠(VPA)及其代谢产物2-丙基-2-戊烯酸(2-ene-VPA)血药浓度的影响。方法:共纳入114例在我院门诊就诊的癫痫病患儿,根据治疗方案分为VPA组(n=71),VPA+LEV组(n=23)以及VPA+OXC组(n=20)。采用RP-HPLC法测定VPA代谢产物2-ene-VPA的血药浓度,并采用SPSS 19.0软件进行统计学分析。结果:VPA+LEV组与VPA组相比,VPA血药浓度的差异无统计学意义(P=0.778);而VPA+OXC组中VPA的血药浓度较单独服用VPA组低,差异有统计学差异(P=0.004)。而在VPA组、VPA+LEV组、VPA+OXC组中,2-ene-VPA血药浓度的差异无统计学意义(P=0.082)。在VPA组中,VPA和2-ene-VPA血药浓度间的正相关关系具有统计学意义(R=0.278,P=0.019)。在VPA+LEV组及在VPA+OXC组中,VPA和2-ene-VPA血药浓度间的相关关系均没有统计学意义(P=0.138;P=0.334)。结论:VPA联合应用OXC时,需根据血药浓度监测结果调整VPA及OXC剂量,VPA联合应用LEV时无需调整VPA剂量;VPA与LEV或OXC合用时不会增加2-ene-VPA的中枢神经系统不良反应。

Effects of Oxcarbazepine and levetiracetam on plasma concentrations of valproic acid and its metabolite 2-Propyl-2-pentenoic Acid in Epileptic children

OBJECTIVE To investigate the effects of Oxcarbazepine and LEV on plasma concentrations of valproic acid(VPA) and its metabolite, 2-Propyl-2-pentenoic Acid(2-ene-VPA) in Epileptic children.METHODS There were 114 epileptic outpatients involved in this study, All patients were divided into three groups by the different treatment strategy (VPA group, n=71; VPA+LEV group, n=23; VPA+OXC group,n=20). The concentration of 2-ene-VPA was determined by RP-HPLC and analyzed by SPSS software 19.0.RESULTS There was no significant difference in the concentration of VPA between the VPA group and VPA+LEV group(P=0.778), while the concentration of VPA was significantly lower in VPA+OXC group than that in VPA group(P=0.004). However, there was no statistical significance in all three groups in 2-ene-VPA concentrations(P=0.082). In VPA group, the positive correlation between 2-ene-VPA and VPA concentrations had statistical significance(R=0.278,P=0.019), while that had no statistical significance in both VPA+OXC group and VPA+LEV group(P=0.138;P=0.334).CONCLUSION VPA dose need to adjust according to blood drug concentration when VPA combined with OXC, while the dosage would not be adjusted when VPA combined with LEV. And the adverse reaction of central nervous system of 2-ene-VPA would not be increased when VPA combined with either OXC or LEV.