摘要
目的探讨4种常用抗癫痫药物(AEDs)对卒中后癫痫(PSE)患者血清同型半胱氨酸(Hcy)、叶酸、维生素B_(12)、维生素B_6水平的影响。方法对规则口服AEDs 1年以上的194例PSE患者(AEDs治疗组)及新诊断未服药的40例PSE患者(对照组)进行血清Hcy、叶酸、维生素B_(12)、维生素B_6水平检测。探讨不同AEDs对患者上述指标的影响。结果与对照组相比,AEDs治疗组血清Hcy水平明显增高,血清叶酸、维生素B_(12)水平明显降低(均P<0.05)。各组间血清维生素B_6水平的差异无统计学意义。与单药治疗亚组比较,联合用药亚组血清Hcy水平明显升高(P<0.05)。与对照组相比,采用丙戊酸钠(VPA)、卡马西平(CBZ)、奥卡西平(OXC)单药治疗的患者血清Hcy水平显著增加,采用VPA、CBZ单药治疗的患者血清叶酸水平明显降低,采用VPA单药治疗的患者血清维生素B_(12)水平明显降低(均P<0.05)。与对照组相比,采用VPA+CBZ、VPA+左乙拉西坦(LEV)、VPA+OXC、CBZ+LEV双药联合治疗及≥3种AEDs联合治疗的患者血清Hcy水平显著增加,采用VPA+LEV、VPA+OXC、CBZ+LEV双药联合治疗及≥3种AEDs联合治疗的患者血清叶酸水平明显降低,采用VPA+CBZ、VPA+OXC、CBZ+LEV双药联合治疗及≥3种AEDs联合治疗的患者血清维生素B_(12)水平明显降低(均P<0.05)。AEDs治疗组高Hcy血症(HHcy)发生率(36.6%)明显高于对照组(20.0%)(χ~2=4.085,P=0.043)。其中联合用药亚组HHcy发生率(47.6%)与对照组比较差异有统计学意义(χ~2=6.950,P=0.008);单药治疗亚组HHcy发生率(33.6%)与对照组比较差异无统计学意义。VPA、CBZ单药治疗的患者HHcy发生率(40.5%;43.8%)明显高于对照组(χ~2=3.871,P=0.049;χ~2=4.726,P=0.030)。OXC、LEV单药治疗的患者HHcy发生率(29.2%;22.9%)与对照组比较差异无统计学意义。结论AEDs治疗对PSE患者血清维生素B_6水平的影响不大,但对其血清Hcy、叶酸、维生素B_(12)水平影响较大。联合应用AEDs或VPA、CBZ单药
Objective To investigate the influence of antiepileptic drugs （AEDs） on levels of serum homocysteine （Hcy） , folate, vitamin B12 and B6 in patients with post-stroke epilepsy （PSE）. Methods The serum levels of Hcy, folate, vitamin B12 and B6 of 194 PSE patients with AEDs treatment for more than 1 year （AEDs treatment group） and 40 newly diagnosed PSE patients without AEDs therapy （control group） were detected. The effects of AEDs on above indexes were analyzed. Results Compared with control group, the serum level of serum Hcy was significantly increased, and the serum levels of folate, B12 were significantly decreased in AEDs treatment group （ all P 〈 0. 05 ）. The difference of the serum levels of vitamin B6 among the groups was not significant. Compared with monothetapy subgroup, the serum levels of Hcy was significantly increased in the combination therapy subgroup （ P 〈 0. 05 ）. Compared with control group, the serum levels of Hcy were significantly increased in patients with Valproate （VPA）, Carbamazepine （CBZ） and Oxcarbazepine （OXC） monotherapy, the serum levels of folate were significantly decreased in patients with VPA and CBZ monotherapy, and the serum level of B12 was significantly decreased in patients with VPA monotherapy （ all P 〈 0. 05 ）. Compared with control group, the serum levels of Hcy were significantly increased in patients with 2 kinds of AEDs combination treatment [ VPA ＋ CBZ, VPA ＋ Levetiracetam （LEV） , VPA ＋ OXC, CBZ ＋ LEVI or ≥3 kinds of AEDs combination treatment, the serum levels of folate was significantly decreased in patients with 2 kinds of AEDs combination treatment （ VPA ＋ LEV, VPA ＋ OXC, CBZ ＋ LEV） or ≥3 kinds of AEDs combination treatment, the serum levels of B12 were siginifieantly decreased in patients with 2 kinds of AEDs combination treatment （ VPA ＋ CBZ, VPA ＋ OXC, CBZ ＋ LEV） or ≥3 kinds of AEDs combination treatment （ all P 〈 0. 05 ）. The incidence of hyperhomoeysteinemia （HHcy�
出处
《临床神经病学杂志》
CAS
北大核心
2017年第2期93-97,共5页
Journal of Clinical Neurology
基金
苏州市科技发展计划(应用基础)(SYS201549)
