卡马西平、托吡酯与丙戊酸钠治疗201例脑炎继发癫痫疗效分析

目的：对卡马西平(CBZ)、托吡酯(TPM)和丙戊酸钠缓释片(VPA)在脑炎继发性癫痫疾病治疗中起到的作用及其负面作用进行分析。方法选取201例脑炎继发性癫痫患者,对其资料进行回顾分析,按用药不同分为VPA(71例)、TPM(61例)、CBZ(69例)三组,而后对其在接受了VPA、TPM及CBZ为期1年的治疗之后的疗效进行比较,从而对药物的负面作用做出评价。结果 CBZ对脑炎继发癫痫的总有效率为72.46%,和VPA的78.87%和TPM 80.33%的差异无统计学意义(P>0.05)。TPM不良反应率明显低于另外两组,差异有统计学意义(P<0.05)。结论在采取单一药物治疗手段时, CBZ在部分发作癫痫上的疗效可观,而TPM和VPA对所有类型的脑炎激发的癫痫均起到不错的疗效,而TPM的负面作用较其余两种更少。     

抗癫痫药物对癫痫儿童血清性激素水平影响的研究

目的探讨抗癫痫药物(ADEs)对癫痫儿童血清性激素水平的影响。方法应用化学发光免疫分析法对125例癫痫患儿进行血清性激素水平测定,并观察各组性激素水平的变化。结果①单药组中丙戊酸钠(VPA)组、托吡酯组(TPM)、左乙拉西坦组(LEV)和联合用药组(VPA+TPM、VPA+LEV、TPM+LEV)其血清睾酮(TSTO)水平有不同程度升高,分别与对照组比较有统计学意义(P<0.05);VPA组雌二醇(E2)降低(P>0.05)、TPM组E2升高(P<0.05)。各组其余4项性激素:孕酮(PRGE)、泌乳素(PRL)、促卵泡生成激素(FSHA)、促黄体生成激素(LH),没有明显变化。②各组服药6、12个月检测TSTO与对照组比较有升高(P<0.05);12和6个月比较TSTO有升高趋势(P>0.05);二者TPM组E2均有升高,但二者比较无统计学意义(P>0.05)。③本组性激素的变化在性别和年龄上无统计学差异。结论服用ADEs对癫痫儿童血清性激素水平有不同程度的影响,提示在治疗期间检测癫痫儿童血清性激素水平的必要性。     

男性糖尿病患者血清睾酮浓度变化与糖尿病微血管病的关系

目的　了解糖尿病患者血清睾酮浓度与微血管病变的关系。方法　测定 30例男性糖尿病患者及 34例正常男性血清睾酮、黄体生成素、卵泡刺激素、泌乳素、雌二醇 ,比较观察糖尿病患者垂体—性腺轴变化。结果糖尿病血清睾酮水平明显低于对照组 ,糖尿病患者中睾酮水平减低组的微血管病变的发生率明显高于睾酮水平正常组 ,其血清黄体生成素水平明显高于血清睾酮水平正常组 ,提示微血管病变在糖尿病患者垂体—性腺轴变化中有一定影响     

男性糖尿病患者血清睾酮浓度变化与糖尿病微血管的关系

目的 了解糖尿病患者血清睾酮浓度与微血管病变的关系。方法 测定３０例男性糖尿病患者及３４例正常男性血清睾酮、黄体生成素、狼泡刺激素、泌乳素、雌二醇,比较观察糖尿病患者垂体一性腺轴变化。结果 糖尿病血清睾酮水平明显低于对照组,糖尿病患者中睾酮水平减低组的微血管病变的发生率明显高于睾酮水平正常组,蓁因清黄体生成素水平明显高于血清睾酮水平正确组,提示微血管病变在糖尿病患者垂体一性腺轴变化中有一定影响。     

托吡酯、卡马西平与丙戊酸钠治疗脑炎继发癫痫效果分析

目的探讨托吡酯(TPM)、卡马西平(CBZ)与丙戊酸钠(VPA)治疗脑炎继发癫痫(SEVE)的效果。方法选取我院2012年2月~2014年2月的96例脑炎继发癫痫患者为研究对象,采用随机数字表法将其均分为TPM组、CBZ组和VPA组。TPM组采用托吡酯,CBZ组采用卡马西平,VPA组采用丙戊酸钠进行治疗,疗程均为1年,观察3组患者治疗后的临床疗效以及不良反应情况。结果治疗后TPM组、CBZ组和VPA组的总有效率分别为84.38%,78.13%,81.25%,3组差异均无统计学意义;而TPM组、CBZ组和VPA组的不良反应发生率分别为9.38%,37.50%,25.00%,差异具有统计学意义。结论托吡酯、卡马西平与丙戊酸钠治疗脑炎继发癫痫患者的临床效果确切,疗效间无差异,但是使用托吡酯的不良反应发生率明显低于卡马西平和丙戊酸钠。     

卵巢储备功能低下不孕不育的中西医结合治疗分析

目的:研究卵巢储备功能低下不孕不育的中西医结合治疗效果。方法:对2015年9月—2016年3月卵巢储备功能低下不孕不育患者82例进行分组研究。西药组采用西药黄体酮胶囊和戊酸雌二醇治疗,中西医组在西药组治疗的基础上增加滋阴补肾汤治疗。比较两组患者成功妊娠率、平均妊娠时间以及用药前后患者卵泡刺激素、血清孕酮、雌二醇、黄体生成素水平的差异。结果:中西医组成功妊娠率高于西药组,差异有统计学意义(P<0.05);中西医组相较于西药组平均妊娠时间更短,差异有统计学意义(P<0.05);用药前两组卵泡刺激素、血清孕酮、雌二醇、黄体生成素水平比较差异无统计学意义(P>0.05);用药后中西医组相较于西药组卵泡刺激素、血清孕酮、雌二醇、黄体生成素改善更显著,差异有统计学意义(P<0.05)。结论:卵巢储备功能低下不孕不育的中西医结合治疗效果确切,可有效改善卵巢储备功能,缩短妊娠时间,提高妊娠率。     

卡马西平、丙戊酸、拉莫三嗪、奥卡西平、托吡酯治疗初发癫痫患者的长期保留率对比

目的探讨卡马西平(CBZ)、丙戊酸(VPA)、拉莫三嗪(LTG)、奥卡西平(OXC)、托吡酯(TPM)治疗初发癫痫患者的长期保留率的差异。方法选取846例于2005年11月至2016年3月入我院的新诊断癫痫患者,依据患者意愿,分别选用卡马西平、丙戊酸、拉莫三嗪、奥卡西平、托吡酯单药治疗,将所有患者分为CBZ组、VPA组、LTG组、OXC组、TPM组5组,并通过随访2年,记录所有患者的药物长期保留率、不良反应、临床疗效、停药时间和停药原因。结果 846例患者中,共有643例(76.00%)2年内一直保持单药治疗,其中,CBZ组、VPA组、LTG组、OXC组、TPM组的保留率分别为73.42%(174/237)、74.48%(251/337)、85.56%(77/90)、78.13%(50/64)、77.12%(91/118),CBZ组和VPA组保留率与LTG组相比,差异有统计学意义(P<0.05),其他组间相比,差异无统计学意义(P>0.05);五组患儿的抗癫痫药物长期保留率组间比较,差异有统计学意义(P<0.05);五组成年患者的抗癫痫药物长期保留率组间比较,差异无统计学意义(P>0.05)。五组患者2年后临床疗效对比,差异无统计学意义(P>0.05)。依从性差是患者停止服药的首要原因。结论在5种药物中,LTG治疗初发癫痫患者的长期保留率最高,不同药物的临床疗效并无显著差异,导致患者停药的首要原因是依从性差。     

性腺领域相关热点问题几点讨论

人体内的内分泌调节是通过许多功能调节＂轴＂（axis）来实现的,性腺轴是由下丘脑、垂体和外周性腺共同构成的。下丘脑的促性腺激素释放激素（GnRH）调节垂体的促性腺激素黄体生成素（LH）和卵泡刺激素（FSH）的分泌。促性腺激素再对外周性腺,即它的靶器官发挥作用。睾丸为男性的外周性腺器官,可合成分泌睾酮、雌激素、抑制素、     

慢性阻塞性肺病血性激素及皮质醇检测及其临床意义

本文对 50例男性慢性阻塞性肺病 (COPD)急性发作期患者及 4 7例对照组进行血性激素及皮质醇检测 ,结果显示 :COPD组血清睾酮、雌二醇及皮质醇显著低于对照组 (P <0 0 5) ,而且黄体生成素 (LH)、卵泡刺激素 (FSH)水平两组间无显著差异。提示COPD患者急性发作期存在明显的性腺、肾上腺及垂体功能异常。     

促性腺激素简介

<正> 促性腺激素(Gonadotropin)主要包括促黄体生成素(Luteinizing hormone,LH)、卵泡刺激素(Follicle-stimulating hormone,FSH)和绒毛膜促性腺激素(Chorionie gonadotropin hormone,HCG)。LH和FSH由垂体前     

341 例癫痫患儿用药特点分析

目的：探讨癫痫患儿临床用药特点,为临床合理应用抗癫痫药物提供参考。方法：回顾性分析2018年2月至2018年8月西北妇女儿童医院和西安交通大学第二附附属医院收治的341例癫痫患儿临床资料,对其用药方案选择及发作控制率进行统计分析。结果：341例癫痫患儿中,男女比例1.04∶1,年龄9个月~19岁,其中1~3岁患儿占比最大,为32.55%。经抗癫痫药物治疗,341例患儿Ⅲ级以上总体发作控制率为84.45%。单药治疗、双药治疗和三种及以上联合治疗Ⅱ级以上控制率分别为94.45%、69.63%和45.56%。单药治疗中使用率前3位的药物分别为左乙拉西坦、苯巴比妥和卡马西平;多药治疗中使用率前3位的药物分别为左乙拉西坦、丙戊酸钠和托吡酯。单药治疗以左乙拉西坦为主,联合治疗主要以左乙拉西坦＋丙戊酸钠或托吡酯为主。结论：儿童癫痫发病以婴幼儿期最多,药物治疗总体控制率较高,新型抗癫痫药和传统抗癫痫药在治疗选择中使用率相当,新型抗癫痫药物左乙拉西坦在各发作类型及各种治疗方案中使用率最高。治疗药物选择主要为左乙拉西坦、苯巴比妥和卡马西平,抗癫痫药物联合治疗方案主要为丙戊酸钠+左乙拉西坦和丙戊酸钠+氯硝西泮+左乙拉西坦。     

The effect of epilepsy and antiepileptic drugs on sexual,reproductive and gonadal health of adults with epilepsy

Epilepsy is a common chronic medical illness. Hyposexuality is the most frequent abnormality in men and women with epilepsy. In men with epilepsy, hypoandrogenimia, hypogonadism and sperm abnormalities are common. Testicular atrophy was also infrequently reported. In women with epilepsy, hyperandrogenism, polycystic ovaries (PCOs) and PCO syndrome are frequent. Decreased serum free testosterone, dehydroepiandrosterone levels, free androgen index and free testosterone/leutinizing hormone (LH) ratio and increased sex hormone binding globulin, estradiol, prolactin, LH, follicle stimulating hormone (FSH) levels and LH/FSH ratio are common with epilepsy. Disturbance of central and/or peripheral control of hypothalamic-pituitary-gonadal axis and alteration of central neurotrasmitters (GABA, glutamate and serotonin) by epileptic discharges or antiepileptic drugs (AEDs), direct gonadal toxicity by AEDs and pcyshicatric/psychosocial factors are all incriminated in sexual, reproductive and gonadal abnormalities associated with epilepsy. Patients may benefit from multidisplinary evaluation, tight seizure control, change the AED, androgen therapy, genital vasodilators, L-carnitine supplementation and psychotherapy.     

Second generation anti-epileptic drugs adversely affect reproductive functions in young non-epileptic female rats

Reproductive endocrine disturbances are a major health concern in women with epilepsy due to their long term use of antiepileptic drugs (AEDs). Second generation AEDs such as topiramate (TPM) and gabapentin are frequently used for the treatment of epilepsy as well as migraine, bipolar disorder etc. Despite the widespread clinical complications, however the definitive mechanism(s) mediating the side effects of TPM and gabapentin remain obscure. The present study was aimed to evaluate the long term effects of TPM and gabapentin on reproductive functions in young female Wistar rats. Estrous cyclicity, ovarian histology as well as estradiol, LH, leptin and insulin hormones level were studied to elucidate the long-term effect of these AEDs monotherapy on reproductive functions in non-epileptic animals. Further to explore the effects on gonadotropin releasing hormone (GnRH) neuroendocrine plasticity, the expression of GnRH, gamma-amino butyric acid (GABA), glutamic acid decarboxylase (GAD), glial fibrilliary acidic protein (GFAP) and polysialylated form of neural cell adhesion molecule (PSA-NCAM) was studied in median eminence (ME) region of these animals by immunohistochemistry, Western blot hybridization and RT-PCR. Our results demonstrate that TPM and gabapentin treatment for 8 weeks cause reproductive dysfunction as ascertained by disturbed hormonal levels and estrous cyclicity as well as alterations in GABAergic system and GnRH neuronal–glial plasticity. Our findings suggest that treatment with TPM and gabapentin disrupts the complete hypothalamo-hypophyseal-gonadal axis (HPG) through GnRH pulse generator in hypothalamus.     

Erythrocyte glutathione, glutathione peroxidase, superoxide dismutase and serum lipid peroxidation in epileptic children with valproate and carbamazepine monotherapy

This prospective study was carried out to determine changes in the antioxidant system in epileptic children receiving long term antiepileptic drugs (AEDs). Levels of erythrocyte glutathione (GSH), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and serum lipid peroxidation were determined in 25 healthy children and 30 epileptic children who had not yet received AEDs. Sixteen patients were treated with valproic acid (VPA) and 14 with carbamazepine (CBZ); 13 months later these parameters were retested. The results showed that SOD and lipid peroxidation levels were increased but the GSH-Px levels were decreased in epileptic children on VPA therapy compared with the control group and the results before treatment. No significant differences of these parameters were found in epileptic children on CBZ therapy compared with the control group and the results before treatment, except that lipid peroxidation level was slightly higher in epileptic patients before treatment. We conclude that antioxidant systems in epileptic children on CBZ therapy are better regulated in comparison with epileptic children on VPA therapy.     

Levetiracetam selectively potentiates the acute neurotoxic effects of topiramate and carbamazepine in the rotarod test in mice

The effect of levetiracetam (LEV) on the acute neurotoxic profiles of various antiepileptic drugs (carbamazepine [CBZ], phenytoin [PHT], phenobarbital [PB], valproate [VPA], lamotrigine [LTG], topiramate [TPM], oxcarbazepine [OXC], and felbamate [FBM]) was evaluated in the rotarod test, allowing the determination of median toxic doses (TD₅₀ values) with respect to impairment of motor coordination in mice. The TD₅₀ of LEV administered singly was 1601 mg/kg. Whilst LEV at 150 mg/kg, being its TID₅₀ (a dose increasing the electroconvulsive threshold by 50%), was without effect with regards to motor coordination impairment associated with PHT, PB, VPA, LTG, OXC, and FBM, it significantly enhanced that associated with CBZ and TPM co-administration. Thus LEV (150 mg/kg) significantly decreased the TD₅₀ of CBZ from 53.6 to 37.3 mg/kg (P < 0.01) and that of TPM from 423 to 246 mg/kg (P < 0.01). In addition LEV (75 mg/kg) significantly decreased the TD₅₀ of TPM from 423 to 278 (P < 0.01). That concurrent measurement of total brain LEV, CBZ, and TPM concentrations showed that concentrations were not significantly different when AEDs were administered singly compared to when they were administered in combination would suggest that there is no pharmacokinetic interaction between these AEDs. Thus, the observed potentialization of the acute neurotoxic effects of CBZ and TPM by LEV is the consequence of a pharmacodynamic interaction. These data support both experimental and clinical published data advocating that LEV may interact with some AEDs by pharmacodynamic mechanisms.     

垂体激素与妊娠高血压综合征关系探讨

目的 探讨垂体激素水平变化与妊娠高血压综合征（妊高征）的关系。方法 选择51例妊高征患者为研究组，39例正常孕妇为对照组。采用放射免疫分析技术测定血清卵泡刺激素（FSH）、黄体生成素（LH）、催乳激素（PRL）水平。结果 重度妊高征组血清FSH、LH、PRL水平显著高于正常妊娠组（P〈0．05）；正常妊娠组产后血清LH、PRL显著降低；妊高征组产后三项指标显著降低（P〈0．001）；妊高征组产后FSH显著低于正常妊娠组（P〈0．0003）、PRL显著高于正常妊娠组（P〈0．05）。结论 妊高征的发生与发展与下丘脑垂体神经内分泌改变有关。     

一线抗癫癎药物血药浓度监测结果分析

目的:对一线抗癫癎药物血药浓度监测结果进行回顾性分析,指导临床合理用药。方法:对801例服用一线抗癫癎药物病人的血药浓度进行分类汇总,并对结果进行统计学分析。结果:各药在有效血药浓度范围内的病例百分率差异显著(P<0.01),分别为丙戊酸钠(VPA)75.2%、苯巴比妥(PB)67.3%、卡马西平(CBZ)53.1%、苯妥英钠(PHT)20.8%。VPA使用率最高,为60.5%,其血药浓度存在性别差异(P<0.01)。CBZ血药浓度存在年龄差异(P<0.01)。多药联用血药浓度升高的病例增加(P<0.01),以PHT/CBZ方案最为突出。CBZ/VPA、PB/VPA方案在控制率、安全性方面比较好。结论:血药浓度监测对癫癎治疗具有极其重要的临床意义。     

卡马西平、丙戊酸钠和托吡酯单药对新诊断部分癫痫患者额叶相关认知功能的影响

目的　研究卡马西平 (CBZ)、丙戊酸钠 (VAP)、托吡酯 (TPM)对新诊断成人部分发作癫痫患者额叶相关认知功能的影响。方法　采用前瞻和随机对照研究 ,对 4 8例新诊断为部分发作伴或不伴全面发作的癫痫患者进行 6项神经心理学测验后 ,随机给予CBZ、VAP、TPM单药治疗 ,1月后复查神经心理学检查。结果　与治疗前比较CBZ组B型连线测验错误数增加 (P <0 .0 5 ) ,汉罗塔 (TowerofHanoi)平均计划时间缩短 (P <0 .0 5 ) ;VAP组Stroop读字正确数增加 (P <0 .0 1) ,威斯康星卡片分类测验(WSCT)错误数下降 (P <0 .0 5 )、非持续错误数下降 (P <0 .0 1) ;TPM组倒背数下降 (P <0 .0 1)。治疗后组间比较 ,有 6项神经心理学指标差异有显著性 ,分别是顺背数 (P <0 .0 5 )、词汇总数 (P <0 .0 1)、Stroop读字时间 (P <0 .0 1)、Stroop读字错误数 (P <0 .0 1)、Stroop读色纠正数 (P <0 .0 5 )以及汉罗塔平均计划时间 (P <0 .0 1)。结论　抗癫痫药物的化学结构和作用机制不同 ,所以 ,对认知功能的影响也不同 ;TPM低剂量起始 ,缓慢加量 ,较低的治疗剂量可降低其对认知功能的影响