托吡酯与传统抗癫痫药对男性癫痫患者垂体-性腺轴的影响比较

目的:比较托吡酯(TPM)与传统抗癫痫药丙戊酸(VPA)、卡马西平(CBZ)对新诊断男性癫痫患者垂体-性腺轴的影响。方法:采用自身前后对照方法。将54例男性癫痫患者随机分为TPM组和传统AED s组,分别给予TPM,VPA,CBZ单药治疗,于用药前和用药后6月观察雌二醇、孕激素、总睾酮、黄体生成素、卵泡刺激素、催乳素的改变,以探讨AED s对垂体-性腺轴的影响。结果:TPM组用药后6月较用药前催乳素明显下降,黄体生成素明显升高(P<0.05),VPA组卵泡刺激素显著下降(P<0.01),CBZ组黄体生成素明显升高(P<0.05)。TPM-CBZ组、VPA-CBZ组组间比较催乳素改变明显(P<0.05)。结论:AED s对癫痫患者的垂体-性腺轴均有一定影响,TPM主要影响垂体激素,可能与其抗癫痫作用机制有关。

A comparative study for the effects of topiramate and traditional antiepileptic drugs on pituitary-gonad axis in male patients with newly diagnosed epilepsy

Objective: To study the effects of antiepileptic drugs(AEDs),topiramate(TPM) and the traditional drugs valproic acid(VPA) and carbamazepine(CBZ)],on pituitary-gonad axis in male patients with newly diagnosed epilepsy.Methods: In a randomized,controlled and self-controlled study,54 male patients with newly diagnosed epilepsy were treated with TPM,VPA or CBZ.The baseline and post-treatment levels of serum dihydroxyestrin(E2),progestogen(P),total testosterone(TT),luteinizing hormone(LH),follicle stimulating hormone(FSH) and prolactin(PRL) were measured,respectively,before and 6 months after treatment.Results: TPM treatment for 6 months significantly decreased PRL and increased LH level(P<0.05);VPA deceased FSH level(P<0.01);CBZ increased LH level(P<0.05) in the serum.There were significant differences in PRL levels between VPA-CBZ and between TPM-CBZ groups(P<0.05).Conclusion: AEDs can affect the pituitary-gonad axis in male epileptic patients.TPM mainly affects pituitary hormone,which may relate to its antiepileptic mechanism.