癫痫儿童服用丙戊酸钠或卡马西平后血同型半胱氨酸的变化

目的:探讨癫痫儿童服用抗癫痫药物丙戊酸钠或卡马西平后血同型半胱氨酸( homocysteine,hcy)水平的变化,以便减少其潜在风险及不利影响.方法:选取67例癫痫患儿,按使用药物分为卡马西平组与丙戊酸钠组.卡马西平和丙戊酸钠的剂量分别为10 ～20 mg/(kg·d)和10～40 mg/(kg·d),并依据血药浓度适度调整剂量,疗程2～5年.在用药前、用药后6个月、用药后1年监测hcy水平,比较各组hcy水平变化.结果:共有67例患儿完成本研究,丙戊酸钠组36例,卡马西平组31例.丙戊酸钠组和卡马西平组hcy在用药前分别为(6.94±2.47)μmoL/L、(8.11±3.04) μmol/L,两组比较差异无统计学意义(P＞0.05)；6个月时分别为(7.42±2.51) μmol/L、( 8.39±2.75) μmol/L,两组比较差异无统计学意义(P＞0.05)；1年后分别为(8.92±2.81) μmol/L、(10.45±3.98) μmol/L,两组hcy水平均较前明显升高(P＜0.01).相关分析未发现癫痫发作及抗癫痫药物浓度与hcy呈明显相关性(P＞0.05).结论:丙戊酸钠或卡马西平引起hcy水平升高,6月以后更明显,临床需注意定期监测癫痫患儿的hcy水平并适当予以干预.

The Homocysteine Changes in Children with Epilepsy after Taking Sodium Valproate or Carbamazepine

Objective: In order to reduce the potential risks and adverse reactions of homocysteine(hcy),the changes of hcy levels were investigated in children with epilepsy after taking antiepileptic drugs such as sodium valproate or carbamazepine.Methods: Sixty-seven children with epilepsy were enrolled.According to different treatments,they were divided into carbamazepine and sodium valproate groups.They received carbamazepine 10~20 mg/(kg·d) or sodium valproate 10~40 mg/(kg·d) respectively,and based on a moderate plasma level of drug concentration to adjust the dose.The treatment course was about two to five years.The hcy levels were measured before treatment,six months after treatment and one year after treatment.The hcy levels’ changes between the two groups were compared.Results: Together 67 cases completed the study,and there were 36 cases in sodium valproate group and 31 cases in carbamazepine group.The hcy levels of two groups were(6.94±2.47) μmol/L and(8.11±3.04) μmol/L before treatment.There were no significant difference between the two groups(P>0.05).After six months the levels were(7.42±2.51) μmol/L and(8.39±2.75) μmol/L respectively,and there was no significant difference either(P>0.05).After one year the levels of hcy were(8.92±2.81) μmol/L and(10.45±3.98) μmol/L.There were significant difference between the two groups(P<0.01).There was no significant correlation between hcy levels and seizure frequency or antiepileptic drug concentrations(P>0.05).Conclusions: Sodium valproate or carbamazepine may induce high hcy levels,especially after six months of treatment.More attention should be paid through regular monitoring of hcy levels to epileptic children and to give them appropriate intervention in clinic.