托吡酯治疗癫痫患儿20例临床分析

目的 探讨托吡酯治疗癫痫患儿的临床疗效，并分析托吡酯对癫痫患儿血糖、胰岛素、皮质醇、瘦素、胃饥饿素和神经肽Y水平及对患儿体重指数的影响。 方法 回顾性分析2011年10月—2013年10月间在浙江省人民医院儿科进行治疗的20例癫痫患儿病例资料。所有患儿均给予5 mg/(kg·d)托吡酯进行治疗，于治疗前、治疗后3个月和6个月时测定患儿空腹血糖、胰岛素、血清瘦素、神经肽Y、胃饥饿素、皮质醇的水平和患儿体重指数。 结果 治疗3个月时，患儿胰岛素水平、身体质量指数(BMI)分别为(4.65±2.28) μU/ml和(15.87±1.90) kg/m2，均显著低于治疗前的(5.83±2.72) μU/ml和(16.44±1.84) kg/m2(P＜0.05)；而治疗6个月时，胰岛素水平比治疗3个月时升高，且与治疗前比较差异无统计学意义(P＞0.05)。治疗6个月时，患儿血清皮质醇和瘦素水平分别为(10.13±4.17) μg/dl和(2.14±2.03) ng/ml，显著低于治疗前的(13.25±5.50) μg/dl和(2.89±2.63) ng/ml](P＜0.05)；治疗前后，患儿的血糖、胃饥饿素和神经肽Y水平无显著性变化(P＞0.05)。 结论 托吡酯治疗癫痫患儿，血清瘦素、皮质醇水平降低，这可能是托吡酯治疗导致癫痫患儿身体质量指数水平下降的重要原因。 

Efficacy of Topiramatein treatment of childrenwith epilepsy

Objective To investigate the efficacy of topiramate in the treatment of children with epilepsy and evaluateits effect on serum glucose,insulin,cortisol,leptin,ghrelin and neuropeptide-Y levels and body mass index. Methods Total 20 cases of pediatric epilepsy in our hospital from October 2011 to October 2013 were retrospectively analyzed.All children were treated with topiramate at a daily dose of 5 mg/kg.Before and after the treatment,the fasting blood glucose,insulin and serum leptin,neuropeptide-Y,ghrelin,cortisol,and BMI levels were detected. Results After 3 months treatment,insulin level and body mass index levels were (4.65±2.28) μU/ml and (15.87±1.90) kg/m2,which were significantly lower than those before the treatment(5.83±2.72) μU/ml and (16.44±1.84) kg/m2],P<0.05.But after 6 months treatment,the insulin level increased as compared with those values after 3 months treatment,and the results had no significantly difference when compared with those values before the treatment(P>0.05).After 6 months treatment,the serum cortisol and leptin levels were (10.13±4.17) μg/dl and (2.14 ±2.03) ng/ml,which were significantly lower than those before the treatment (13.25±5.50) μg/dl and (2.89±2.63) ng/ml],P<0.05.Before and after the treatment,there were no significant differences on serum glucose,ghrelin or neuropeptide-Y levels. Conclusion In treatment of children with epilepsy,topiramate can reduce serum leptin and cortisol levels,which might be the key reasons of the decrease of body mass index.