传统抗癫痫药物与新抗癫痫药物对癫痫患者身体成分及脂代谢的影响

目的比较新抗癫痫药物与传统抗癫痫药物对患者身体成分及脂代谢的影响。方法收集我院癫痫患者112例。患者均服用新抗癫痫药(左乙拉西坦、拉莫三嗪、加巴喷丁)或传统抗癫痫药(丙戊酸钠、卡马西平、苯妥英钠)至少6个月。单一用药治疗73例,其中,服用左乙拉西坦片14例、丙戊酸钠15例、卡马西平20例、苯妥英钠24例。其余患者采用联合用药治疗。评估患者身体成分,包括体脂量、瘦干体质量(Lean dry mass,LDM),记录总体液量(Total body water,TBW)、细胞内液(Intracellular water,ICW)、细胞外液(Extracellular water,ECW)、基础代谢率(Basal metabolic rate,BM R),检测生化指标参数。结果左乙拉西坦组患者LDM较丙戊酸钠组患者降低(P<0.05),而其他身体成分与丙戊酸钠组、卡马西平组、苯妥英钠组比较差异无统计学意义(P>0.05)。与对照组比较,丙戊酸钠治疗组LDM及细胞外液较高;其余抗癫痫药物单一用药治疗组的身体成分与对照组比较差异无统计学意义(P>0.05)。传统抗癫痫药物单一治疗及联合新型药治疗组患者的LDM高于对照组(P<0.05),血清TC、三酰甘油也高于对照组(P<0.05)。结论抗癫痫药物对身体成分及脂代谢的影响作用可能影响其对癫痫患者(特别是身体成分发生变化的患者)的治疗反应。由于样本量的限制,以上结论需进一步大样本及前瞻性研究。

Comparison of effect of conventional and new antiepileptic drugs on body composition and lipid profile in patients with epilepsy

Objective To compare the effect of new and conventional antiepileptic drugs on body composition and lipid profile in patients with epilepsy.Methods Totally 112 cases with epilepsy treated with conventional antiepileptic drugs (valproate,carbamazepine and phenytoin) or new antiepileptic drugs (levetiracetam,lamotrigine and gabapentin) for more than 6 months in our hospital were collected.Seventy-three cases were given monotherapy of levetiracetam (n=14),valproate (n=15),carbamazepine (n=20) and phenytoin (n=24),respectively,and the other 39 cases received combined medication therapy.The body composition,including body fat mass and lean dry mass (LDM),was estimated,and the total body water (TBW),intracellular water (ICW),extracellular water (ECW) and basal metabolic rate (BMR) were recording,and then the biochemical parameters were assessed.Results Levetiracetam group had lower LDM than valproate group (P<0.05),but no significant difference was observed in body composition between levetiracetam group and other groups (including valproate,carbamazepine,phenytoin and control groups) (P>0.05).Valproate group had higher LDM and ECW than control group (P<0.05),but no significant difference was found in body composition between other AEDs monotherapy groups and control group (P>0.05).The LDM in conventional antiepileptic drug groups was higher than that of control group (P<0.05),but there was no significant difference between other groups and control group (P>0.05).The levels of TC and TG in conventional antiepileptic drug groups and combined (conventional and new antiepileptic drug) group were higher than those of control group (P<0.05).Conclusion The influence of antiepileptic drugs on body composition can affect the efficacy in epilepsy,especially in the patients with altered body composition,which should be confirmed by further,large sample and prospective study.