抗癫痫药物与血脂异常相关性的Meta分析

目的 运用Meta分析方法评估抗癫痫药物与血脂异常的相关性,为合理选择抗癫痫药物及明确抗癫痫药物对血脂异常的不良影响提供更为有利的依据.方法 以"抗癫痫药"、抗惊厥药"及"血脂"为关键词对万方、维普及中国知网三大数据库建库至2017年3月所有文献进行检索.仅纳入关于抗癫痫药物与血脂异常的病例对照研究及队列研究.对所纳入的文献进行客观的评价质量后,采用RevMan5.3分析软件进行数据分析.结果 最终纳入18篇研究,共878例研究对象,涉及到的抗癫痫药物包括丙戊酸钠、卡马西平、苯妥英钠、苯巴比妥、拉莫三嗪及托吡酯.Meta分析结果示丙戊酸钠会导致总胆固醇(TC)、高密度脂蛋白(HDL-C)及低密度脂蛋白(LDL-C)水平的增加,差异具有显著统计学意义(P<0.01);卡马西平会增加TC、甘油三酯(TG)、HDL-C及LDL-C的水平,差异有显著统计学意义(P<0.01).苯妥英钠会降低TC、TG及LDL-C的血清水平,差异具有显著统计学意义(P<0.01).结论 抗癫痫药可能会改变癫痫患者血脂水平,尤其是卡马西平、丙戊酸钠及苯妥英钠.临床医生及癫痫患者都需提高对血脂异常的管理,从而避免血管疾病的发生.

Correlation between antiepileptic drugs and dyslipidemia:a meta-analysis

Objective To evaluate the correlation between antiepileptic drugs and dyslipidemia through me-ta-analysis, which provided more favorable basis for rational selection of antiepileptic drugs and clinical study of adverse effects of dyslipidemia. Methods A comprehensive literature search with"antiepileptic drugs","anticonvulsants"and"se-rum insulin"as keywords was conducted through Wanfang, VIP and CNKI up to March 2017. The case-control study and cohort study of antiepileptic drugs and dyslipidemia were included. After evaluating the quality of the literature, Rev-Man5.3 analysis software was used to analyze the data. Results A total of 18 studies, which involved 878 subjected and related to antiepileptic drugs including sodium valproate, carbamazepine, phenytoin, phenobarbital, lamotrigine and topira-mate, were included. The results of meta-analysis showed that sodium valproate could lead to significant increase of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels (P<0.01). Carbamazepine could lead to significant increase of TC, triglycerides (TG), HDL-C and LDL-C levels (P<0.01). Phenytoin could significantly decrease the serum levels of TC, TG and LDL-C (P<0.01). Conclusion Antiepileptic drugs may alter the lipid levels of patients with epilepsy, especially carbamazepine, sodium valproate and phenytoin. Clinicians and epilepsy patients need to improve the management of dyslipidemia, so as to avoid the occurrence of vascular disease.