用左乙拉西坦治疗首诊癫的疗效及对病人骨代谢和骨密度的影响
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摘要
目的:探讨用左乙拉西坦治疗首诊癫的疗效及对病人骨代谢和骨密度的影响。方法:选取2015年6月-2017年5月解放军第一O一医院收治的首诊癫病人66例,分为A组(左乙拉西坦片治疗,33例)和B组(卡马西平治疗,33例),比较两组病人的疗效、药品不良反应(ADRs)及治疗前、治疗后6个月骨代谢和骨密度水平。结果:A组病人与B组病人治疗总有效率比较差异无统计学意义。两组病人头晕、头痛、嗜睡、恶心、呕吐、肝功能损伤、情绪改变发生率比较差异无统计学意义。治疗前,两组病人血钙、血磷、碱性磷酸酶、甲状旁腺激素水平比较差异也无统计学意义。治疗6个月后,B组病人血钙水平低于A组及自身治疗前,血磷、碱性磷酸酶水平高于A组及自身治疗前(P<0.05)。治疗前,两组病人腰椎、股骨大转子、股骨颈、Ward三角骨密度水平比较差异无统计学意义;治疗6个月后,B组病人股骨大转子、股骨颈、Ward三角骨密度较自身治疗前均显著下降(P<0.05);A组病人这些部位骨密度与治疗前比较差异无统计学意义。结论:用左乙拉西坦治疗首诊癫病人具有显著疗效和较高用药安全性,相对卡马西平能减轻对病人骨代谢和骨密度的影响。
Objective:To investigate the curative effects of levetiracetam on the patients with first diagnosed epilepsy,as well as bone metabolism and bone mineral density(BMD).Methods:Totally,66 cases of first diagnosed epilepsy treated in No.101 Hospital of PLA from June 2015 to May 2017 were enrolled as study subjects,and were divided into group A(with levetiracetam treatment,n=33)and group B(with carbamazepine treatment,n=33).The curative effects,adverse drug reactions(ADRs),bone metabolism and BMD before treatment and 6 months after treatment were compared between the patients of the 2 groups.Results:Total effective rate of the patients in group A and group B was not statistically different.The rates of dizziness,headache,drowsiness,nausea and vomiting,hepatic function injury and mood change in the patients of both groups were also not statistically different.There was no statistical significance in the levels of serum calcium,phosphorus,alkaline phosphatase and parathyroid hormone,when comparisons were made between the 2 groups before treatment.However,6 months after treatment,the level of serum calcium in group B was lower than that of group A,and was also lower than that of itself before treatment.The levels of serum phosphorus and alkaline phosphatase in group B were higher than those of group A and were also higher than those itself before treatment(P<0.05).Before treatment,there was no statistical significance in the bone mass density of lumbar vertebrae,femoral trochanter,femoral neck and Ward triangle in the 2 groups.However,after 6 months of treatment,the BMD of femoral trochanter,femoral neck and Ward triangle of group B decreased significantly,as compared with that before treatment(P<0.05),while for the patients of group A,there were no statistical differences in the BMD of these sites,when comparisons were made with those before treatment(P>0.05).Conclusion:Levetiracetam in the treatment of patients with first diagnosed epilepsy could produce significant curative effects with high medication safety.Furthermore,it could lower the impact on bone metabolism and BMD,as compared with carbamazepine.
Objective:To investigate the curative effects of levetiracetam on the patients with first diagnosed epilepsy,as well as bone metabolism and bone mineral density(BMD).Methods:Totally,66 cases of first diagnosed epilepsy treated in No.101 Hospital of PLA from June 2015 to May 2017 were enrolled as study subjects,and were divided into group A(with levetiracetam treatment,n=33)and group B(with carbamazepine treatment,n=33).The curative effects,adverse drug reactions(ADRs),bone metabolism and BMD before treatment and 6 months after treatment were compared between the patients of the 2 groups.Results:Total effective rate of the patients in group A and group B was not statistically different.The rates of dizziness,headache,drowsiness,nausea and vomiting,hepatic function injury and mood change in the patients of both groups were also not statistically different.There was no statistical significance in the levels of serum calcium,phosphorus,alkaline phosphatase and parathyroid hormone,when comparisons were made between the 2 groups before treatment.However,6 months after treatment,the level of serum calcium in group B was lower than that of group A,and was also lower than that of itself before treatment.The levels of serum phosphorus and alkaline phosphatase in group B were higher than those of group A and were also higher than those itself before treatment(P<0.05).Before treatment,there was no statistical significance in the bone mass density of lumbar vertebrae,femoral trochanter,femoral neck and Ward triangle in the 2 groups.However,after 6 months of treatment,the BMD of femoral trochanter,femoral neck and Ward triangle of group B decreased significantly,as compared with that before treatment(P<0.05),while for the patients of group A,there were no statistical differences in the BMD of these sites,when comparisons were made with those before treatment(P>0.05).Conclusion:Levetiracetam in the treatment of patients with first diagnosed epilepsy could produce significant curative effects with high medication safety.Furthermore,it could lower the impact on bone metabolism and BMD,as compared with carbamazepine.
引文
[1] Yilmaz K,Karatoprak E Y.Epilepsy classification and additional definitions in occipital lobe epilepsy[J].Epileptic Disord,2015,17(3):299-307.
[2] LU YunFeng,Worrell G A,Zhang H C,et al.Noninvasive imaging of the high frequency brain activity in focal epilepsy patients[J].IEEE Trans Biomed Eng,2014,61(6):1660-1667.
[3]李满棠.成年人癫与骨代谢的关系研究[J].中国全科医学,2017,20(25):3140-3143.LI ManTang.Correlation between epilepsy and bone metabolism in adults[J].Chin Gen Pract,2017,20(25):3140-3143.In Chinese with English abstract.
[4]马淑芳,邹丽萍.癫与骨代谢的相关性研究的进展[J].中华保健医学杂志,2017,19(2):180-181.MA ShuFang,ZOU LiPing.Progress in the study of the relationship between epilepsy and bone metabolism[J].Chin J Health Care Med,2017,19(2):180-181.In Chinese.
[5] Schiecke K,Wacker M,Piper D,et al.Time-variant,frequency-selective,linear and nonlinear analysis of heart rate variability in children with temporal lobe epilepsy[J].IEEE Trans Biomed Eng,2014,61(6):1798-1808.
[6]曹治华,周佩洋,洪艳.抗癫药物对癫患者骨密度的影响[J].中国实用神经疾病杂志,2016,19(8):90-91.CAO ZhiHua,ZHOU PeiYang, HONG Yan.Effect of antiepileptic drugs on bone mineral density in patients with epilepsy[J].Chin J Pract Nerv Dis,2016,19(8):90-91.In Chinese.
[7]张芳,李桂新.抗癫药对癫患儿骨代谢及生活质量的影响[J].陕西医学杂志,2016,45(1):28-30.ZHANG Fang,LI GuiXin.Effect of antiepileptic drugs on bone metabolism and quality of life in children with epilepsy[J].Shaanxi Med J,2016,45(1):28-30.In Chinese.
[8] Losurdo A,Proserpio P,Cardinale F,et al.Drug-resistant focal sleep related epilepsy:results and predictors of surgical outcome[J].Epilepsy Res,2014,108(5):953-962.
[9]陈开杰,周凯琴,房光萃,等.癫患者卡马西平血药浓度监测及影响因素分析[J].中国药业,2015,24(21):60-62.CHEN KaiJie,ZHOU KaiQin,FANG GuangCui,et al.Blood concentration monitoring of carbamazepine in epileptic patients and analysis of its influential factors[J].China Pharmaceuticals,2015,24(21):60-62.In Chinese with English abstract.
[10]黄伟.卡马西平联合丙戊酸钠与单用卡马西平治疗癫的疗效及不良反应对比[J].中国实用神经疾病杂志,2016,19(14):119-120.HUANG Wei.Comparisons of efficacy and adverse drug reactions of carbamazepine plus valproate and carbamazepine alone in the treatment of epilepsy[J].Chin J Pract Nerv Dis,2016,19(14):119-120.In Chinese.
[11]李龙宽,谢娟,张玲敏,等.左乙拉西坦及奥卡西平对癫患儿丙戊酸钠及其代谢产物2-丙基-2-戊烯酸血药浓度的影响[J].中国医院药学杂志,2016,36(1):41-45.LI LongKuan,Xie Juan,ZHANG LingMin,et al.Effects of oxcarbazepine and levetiracetam on plasma concentrations of valproic acid and its metabolite 2-propyl-2-pentenoic acid in epileptic children[J].Chin Hosp Pharm J,2016,36(1):41-45.In Chinese with English abstract.
[12]杨骏保,王晓东,刘灵慧.卡马西平对老年癫患者认知功能及情绪的影响[J].中国老年学杂志,2016,36(3):627-628.YANG JunBao,WANG XiaoDong,LIU LingHui.Effect of carbamazepine on cognitive function and mood in elderly patients with epilepsy[J].Chin J Gerontol,2016,36(3):627-628.In Chinese.
[13]张守利,莫亚玲,赵德运,等.左乙拉西坦单药治疗癫患儿临床效果及其对骨代谢的影响[J].河北医科大学学报,2015,36(9):1076-1079.ZHANG ShouLi,MO YaLing,ZHAO DeYun,et al.Clinical effect of levetiracetam on epileptic children and its effect on bone metabolism[J].J Hebei Med Univ,2015,36(9):1076-1079.In Chinese.
[14] Medarevic D,Kachrimanis K,Djuric′Z,et al.Influence of hydrophilic polymers on the complexation of carbamazepine with hydroxypropyl-beta-cyclodextrin[J].Eur J Pharm Sci,2015,78:273-285.
[15]刘勇,陈胜利,刘靓,等.左乙拉西坦和卡马西平对新诊癫患者神经认知功能和骨代谢的影响[J].现代中西医结合杂志,2016,25(18):1978-1980.LIU Yong,CHEN ShengLi,LIU Liang,et al.Effects of levetiracetam and carbamazepine on neurocognitive function and bone metabolism in patients with newly diagnosed epilepsy[J].Mod J Integr Tradit Chin West Med,2016,25(18):1978-1980.In Chinese.
[2] LU YunFeng,Worrell G A,Zhang H C,et al.Noninvasive imaging of the high frequency brain activity in focal epilepsy patients[J].IEEE Trans Biomed Eng,2014,61(6):1660-1667.
[3]李满棠.成年人癫与骨代谢的关系研究[J].中国全科医学,2017,20(25):3140-3143.LI ManTang.Correlation between epilepsy and bone metabolism in adults[J].Chin Gen Pract,2017,20(25):3140-3143.In Chinese with English abstract.
[4]马淑芳,邹丽萍.癫与骨代谢的相关性研究的进展[J].中华保健医学杂志,2017,19(2):180-181.MA ShuFang,ZOU LiPing.Progress in the study of the relationship between epilepsy and bone metabolism[J].Chin J Health Care Med,2017,19(2):180-181.In Chinese.
[5] Schiecke K,Wacker M,Piper D,et al.Time-variant,frequency-selective,linear and nonlinear analysis of heart rate variability in children with temporal lobe epilepsy[J].IEEE Trans Biomed Eng,2014,61(6):1798-1808.
[6]曹治华,周佩洋,洪艳.抗癫药物对癫患者骨密度的影响[J].中国实用神经疾病杂志,2016,19(8):90-91.CAO ZhiHua,ZHOU PeiYang, HONG Yan.Effect of antiepileptic drugs on bone mineral density in patients with epilepsy[J].Chin J Pract Nerv Dis,2016,19(8):90-91.In Chinese.
[7]张芳,李桂新.抗癫药对癫患儿骨代谢及生活质量的影响[J].陕西医学杂志,2016,45(1):28-30.ZHANG Fang,LI GuiXin.Effect of antiepileptic drugs on bone metabolism and quality of life in children with epilepsy[J].Shaanxi Med J,2016,45(1):28-30.In Chinese.
[8] Losurdo A,Proserpio P,Cardinale F,et al.Drug-resistant focal sleep related epilepsy:results and predictors of surgical outcome[J].Epilepsy Res,2014,108(5):953-962.
[9]陈开杰,周凯琴,房光萃,等.癫患者卡马西平血药浓度监测及影响因素分析[J].中国药业,2015,24(21):60-62.CHEN KaiJie,ZHOU KaiQin,FANG GuangCui,et al.Blood concentration monitoring of carbamazepine in epileptic patients and analysis of its influential factors[J].China Pharmaceuticals,2015,24(21):60-62.In Chinese with English abstract.
[10]黄伟.卡马西平联合丙戊酸钠与单用卡马西平治疗癫的疗效及不良反应对比[J].中国实用神经疾病杂志,2016,19(14):119-120.HUANG Wei.Comparisons of efficacy and adverse drug reactions of carbamazepine plus valproate and carbamazepine alone in the treatment of epilepsy[J].Chin J Pract Nerv Dis,2016,19(14):119-120.In Chinese.
[11]李龙宽,谢娟,张玲敏,等.左乙拉西坦及奥卡西平对癫患儿丙戊酸钠及其代谢产物2-丙基-2-戊烯酸血药浓度的影响[J].中国医院药学杂志,2016,36(1):41-45.LI LongKuan,Xie Juan,ZHANG LingMin,et al.Effects of oxcarbazepine and levetiracetam on plasma concentrations of valproic acid and its metabolite 2-propyl-2-pentenoic acid in epileptic children[J].Chin Hosp Pharm J,2016,36(1):41-45.In Chinese with English abstract.
[12]杨骏保,王晓东,刘灵慧.卡马西平对老年癫患者认知功能及情绪的影响[J].中国老年学杂志,2016,36(3):627-628.YANG JunBao,WANG XiaoDong,LIU LingHui.Effect of carbamazepine on cognitive function and mood in elderly patients with epilepsy[J].Chin J Gerontol,2016,36(3):627-628.In Chinese.
[13]张守利,莫亚玲,赵德运,等.左乙拉西坦单药治疗癫患儿临床效果及其对骨代谢的影响[J].河北医科大学学报,2015,36(9):1076-1079.ZHANG ShouLi,MO YaLing,ZHAO DeYun,et al.Clinical effect of levetiracetam on epileptic children and its effect on bone metabolism[J].J Hebei Med Univ,2015,36(9):1076-1079.In Chinese.
[14] Medarevic D,Kachrimanis K,Djuric′Z,et al.Influence of hydrophilic polymers on the complexation of carbamazepine with hydroxypropyl-beta-cyclodextrin[J].Eur J Pharm Sci,2015,78:273-285.
[15]刘勇,陈胜利,刘靓,等.左乙拉西坦和卡马西平对新诊癫患者神经认知功能和骨代谢的影响[J].现代中西医结合杂志,2016,25(18):1978-1980.LIU Yong,CHEN ShengLi,LIU Liang,et al.Effects of levetiracetam and carbamazepine on neurocognitive function and bone metabolism in patients with newly diagnosed epilepsy[J].Mod J Integr Tradit Chin West Med,2016,25(18):1978-1980.In Chinese.