抗癫痫药对成人骨密度的影响

目的 :探讨抗癫痫药对成年病人骨密度的影响 ,分析引起骨密度降低的可能的危险因素。方法 :对 5 6例成年病人 (男 32例、女 2 4例 )进行了检查和随访。这些病人进行了骨密度测定 ,以及血清钙离子 (Ca2 + )、磷离子(P3 + )、碱性磷酸酶 (ALP)、与骨代谢相关 2 5 羟维生素D(2 5 OHD)浓度的测定。结果 :5 6例病中骨密度正常占5 5 3% (31人 )、骨质疏松占 1 2 .9% (6人 )、骨量减少占 31 .8% (1 9人 ) ,抗痫药引起骨密度降低以腰椎明显 ,尤以腰1最显著 ,腰 1和腰 2 - 4两值分别为 - 0 .6 6± 0 .89和 - 0 .4 1± 0 .98。多药比单药更易引起骨密度降低 ,两者间有差异。酶诱导剂组和非酶诱导剂组间差异无显著。患者的骨密度与服药时间有显著相关性 ,其余因素则无显著影响。结论 :长期服用抗痫药是引起骨密度降低重要危险因素 ,使用单药治疗比多药治疗对骨密度降低的影响小 ,骨密度降低以腰椎为明显

Effect of Antiepileptic Drug on Bone Mineral Density in Adult Epileptic Patients

Objective: To determine the effect of AED on bone density in adult epileptic patients. Methods: 56 ambulatory adult epileptic patients on chronic AED therapy for at least 6 months were included in the study. Bone mineral density (BMD)was measured by Dual X ray Absorptiometry (DXA). Serum calcium(Ca 2+ ) levels,serum phosphate(P 3+ ) levels,serum alkaline phosphatase (ALP) levels were measured as usual. Serum 25 hydroxy vitamin D(25 OHD)levels were measured by RIA. Results: Twenty five adults had low BMD (osteopenia or osteoporosis) at the lumbar spine enriched in bone trabeculae (such as L1 4). Patients having multiple therapy had lower spine BMD than those receiving single therapy. Duration of therapy was significantly correlated with BMD. Serum calcium (Ca 2+ ) levels,serum phosphate (P 3+ ) levels,serum alkaline phosphatase (ALP) levels,serum 25 hydroxy vitamin D(25 OHD)levels were not correlated with BMD. The BMD of subjects on enzyme inducing drugs such as phenytoin(PHT),Phenobarbital(PB),and carbamazepine (CBZ) were similar to those on noninducers such as valproicacid(VPA),lamotrigine(LTG),clonazepam(CNZ),andtopamirate (TPM).Conclusion: Long term antiepileptic drug use and multiple therapy are risk factors for lowered BMD. Skeletal monitoring (especially L1 4) is necessary to patients on chronic antiepileptic therapy.