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。

Long-term retention rates of carbamazepine,valproate,lamotrigine,oxcarbazepine and topiramate in the treatment of patients with primary epilepsy

Objective To explore the difference in long-term retention rates of carbamazepine,valproate,lamotrigine,oxcarbazepine and topiramate in the treatment of patients with primary epilepsy.Methods Totally 846 cases of newly diagnosed epilepsy from November 2005 to March 2016 in our hospital were selected,and they were treated with carbamazepine,valproate,lamotrigine,oxcarbazepine and topiramate according to the desire of patients,respectively.The long-term retention rate,adverse reaction,clinical curative effect and the reasons and time of drug withdrawal were recorded in the following 2 years.Results Totally 643 cases(76.00%) took the raw drug in the 2 years,and the long-term retention rates of CBZ group,VPA group,LTG group,OXC group and TPM group were 73.42%(174/237),74.48%(251/337),85.56%(77/90),78.13%(50/64) and 77.12%(91/118),respectively.The long-term retention rate of CBZ group was significantly higher than those of VPA group and LTG group (P<0.05),and there was no difference among other groups(P>0.05).The long-term retention rates among the 5 child-groups were significantly different(P<0.05),but there was no significant difference among the 5 adult-groups (P>0.05).There was no significant difference in clinical efficacy among the 5 groups (P>0.05).Poor compliance was the primary cause of patients to stop taking the drug.Conclusion Among the 5 drugs,the long-term retention rate of LTG in the treatment of patients with primary epilepsy is the highest,and there is no significant difference in the clinical curative effect among different drugs.Poor compliance is the primary cause of patients to stop taking the drug.