本文關(guān)鍵詞： 丙戊酸 左乙拉西坦 學(xué)齡前期 學(xué)齡期 骨代謝　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：癲癇是最常見(jiàn)的神經(jīng)系統(tǒng)疾病之一,據(jù)統(tǒng)計(jì)全世界約有五千萬(wàn)人罹患癲癇。從上世紀(jì)出現(xiàn)抗癲癇藥物可影響患者骨代謝的報(bào)道以來(lái),全球越來(lái)越多的神經(jīng)病學(xué)專(zhuān)家、學(xué)者開(kāi)始重視抗癲癇藥物對(duì)骨代謝的不良反應(yīng)。在我國(guó),約有60%的癲癇患者起病于兒童期,同時(shí)兒童期的骨骼生長(zhǎng)在人的一生中起著尤為重要的作用,因此探究抗癲癇藥對(duì)兒童骨代謝是否存在影響及其作用機(jī)制成為研究的重中之重。在可用于兒童的抗癲癇藥物中最常見(jiàn)的是丙戊酸鈉(valproate,VPA),卡馬西平(carbamazepine,CBZ),以及新型抗癲癇藥物奧卡西平(Oxc-arbazepine,0XC)、左乙拉西坦(levetiracetam,LEV)等。多數(shù)研究認(rèn)為肝酶誘導(dǎo)型抗癲癇藥物主要是通過(guò)影響肝酶系統(tǒng)引起維生素D代謝增加進(jìn)而導(dǎo)致代謝性骨病。近來(lái),另有研究顯示非肝酶誘導(dǎo)的抗癲癇藥同樣可以引起骨代謝異常,然而其機(jī)制尚不清楚。因此,進(jìn)一步探討非肝酶誘導(dǎo)劑型抗癲癇藥(丙戊酸、左乙拉西坦)對(duì)兒童骨代謝的影響是十分必要的。目的了解丙戊酸、左乙拉西坦單藥治療對(duì)學(xué)齡前期及學(xué)齡期兒童骨代謝的影響,探討其可能的機(jī)制。方法選擇學(xué)齡前期癲癇患兒39例,分別予單藥治療丙戊酸20例、左乙拉西坦19例;學(xué)齡期患兒40例,.分別予單藥治療丙戊酸21例、左乙拉西坦19例,作為觀察組;同時(shí)選擇正常體檢兒童41例,其中學(xué)齡前期21例、學(xué)齡期20例,作為對(duì)照組。分別記錄健康對(duì)照組及各觀察組治療前、治療3個(gè)月后、治療6個(gè)月后的血清鈣、磷、堿性磷酸酶(ALP)、25羥基維生素D[25-(OH)D]水平,并進(jìn)行比較。結(jié)果丙戊酸和左乙拉西坦治療前的學(xué)齡前期及學(xué)齡期患兒的骨代謝水平與健康對(duì)照組均無(wú)顯著性差異(P0.05)。左乙拉西坦單藥治療的學(xué)齡前期和學(xué)齡期患兒其治療3個(gè)月后、6個(gè)月后的血清鈣、磷、ALP、25-(OH)D水平較治療前無(wú)明顯變化(P0.05);丙戊酸單藥治療學(xué)齡前期患兒其治療3個(gè)月后、6個(gè)月后的血清鈣、磷、ALP、25-(OH)D較治療前無(wú)明顯變化(P0.05);丙戊酸單藥治療6個(gè)月后的學(xué)齡期患兒的血清ALP較治療前升高(P0.05),鈣、磷、25-(OH)D較治療前差異不顯著(P0.05)。結(jié)論左乙拉西坦單藥治療對(duì)學(xué)齡前期及學(xué)齡期患兒骨代謝影響不大;丙戊酸單藥治療6個(gè)月內(nèi)即對(duì)學(xué)齡期兒童堿性磷酸酶產(chǎn)生影響。
[Abstract]:Epilepsy is one of the most common diseases of the nervous system. According to statistics, about 50 million people worldwide suffer from epilepsy. Since 0th century, there have been reports that antiepileptic drugs can affect bone metabolism in patients. Scholars have begun to attach importance to the adverse effects of antiepileptic drugs on bone metabolism. In China, about 60% of epileptic patients develop diseases in childhood, and the growth of bones in childhood plays a particularly important role in human life. The most common antiepileptic drugs used in children are valproate VPAA, carbamazepine carbamazepine (CBZ), and new antiepileptic drugs. Eclampsia drugs Oxc-arbazepine (Oxc-arbazepine), levoethoxetam (levetiracetaml) et al. Most studies suggest that liver enzyme inducible antiepileptic drugs increase vitamin D metabolism and lead to metabolic osteopathy by affecting the liver enzyme system. Other studies have shown that non-hepatic enzyme induced antiepileptic drugs can also cause abnormal bone metabolism, but its mechanism is not clear. Therefore, we further explore non-hepatic enzyme inducer type antiepileptic drugs (valproic acid, valproic acid, valproic acid, valproic acid, valproic acid, valproic acid). Objective to investigate the effect of valproic acid and levoethoxetam on bone metabolism in preschool and school-age children. Methods 39 children with pre-school epilepsy were treated with valproic acid (n = 20), levoethylacetam (n = 19), school-age children (n = 40), valproic acid (n = 21) and levoethoxetam (n = 19). As the observation group, 41 children with normal physical examination were selected as the control group. The serum calcium levels were recorded before treatment, 3 months after treatment and 6 months after treatment in the healthy control group and the observation group respectively, including 21 cases of pre-school age and 20 cases of school age. Phosphorous, alkaline phosphatase (ALP) 25 hydroxyvitamin D [25-OHH], Results there was no significant difference in bone metabolism between pre-school and school-age children with valproic acid and levoethoxetam compared with the control group (P 0.05). The preschool age and school age patients treated with levoethoxetam alone were not significantly different from those in the healthy control group (P < 0.05). After 3 months of treatment, 6 months of treatment of serum calcium, There was no significant change in the level of OHN D in ALPX 25-OHN group compared with that before treatment, and the serum calcium level in patients with pre-school children treated with valproic acid for 3 months and 6 months after treatment was similar to that of pre-school children, and there was no significant difference between the two groups before and after treatment. There was no significant change in serum ALP of children of school age after 6 months of valproic acid treatment, and the levels of serum ALP were higher than those before treatment. There was no significant difference between pre-treatment and pre-treatment. Conclusion Levoethylacetam alone has little effect on bone metabolism in preschool and school-age children, while valproic acid alone has an effect on alkaline phosphatase in school-age children within 6 months.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R742.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 羅志紅;楊斌;;奧卡西平對(duì)癲癇患兒骨代謝的影響[J];安徽醫(yī)藥;2016年09期

2 田甜;;丙戊酸對(duì)癲癇患者骨密度與認(rèn)知功能的影響[J];中國(guó)實(shí)用神經(jīng)疾病雜志;2016年12期

3 丁晶;汪昕;;癲癇診療指南解讀[J];臨床內(nèi)科雜志;2016年02期

4 張芳;李桂新;;抗癲癇藥對(duì)癲癇患兒骨代謝及生活質(zhì)量的影響[J];陜西醫(yī)學(xué)雜志;2016年01期

5 張守利;莫亞玲;趙德運(yùn);東蕾;;左乙拉西坦單藥治療癲癇患兒臨床效果及其對(duì)骨代謝的影響[J];河北醫(yī)科大學(xué)學(xué)報(bào);2015年09期

6 Ying ZHANG;Yu-xin ZHENG;Jun-ming ZHU;Jian-min ZHANG;Zhe ZHENG;;抗癲癇藥物影響兒童骨礦物質(zhì)密度及骨代謝的薈萃分析（英文）[J];Journal of Zhejiang University-Science B(Biomedicine & Biotechnology);2015年07期

7 王燦;馬虹英;王方杰;孔愛(ài)英;;丙戊酸肝毒性的早期預(yù)警及預(yù)防研究狀況[J];中國(guó)臨床藥理學(xué)雜志;2015年02期

8 楊春松;張伶俐;林蕓竹;王芳;;國(guó)內(nèi)兒童應(yīng)用托吡酯安全性的文獻(xiàn)分析[J];中華婦幼臨床醫(yī)學(xué)雜志(電子版);2014年05期

9 張新菊;李融;;骨代謝標(biāo)志物相關(guān)研究進(jìn)展[J];山東醫(yī)藥;2014年16期

10 陳念;王立平;;卡馬西平在臨床常見(jiàn)的藥物不良反應(yīng)[J];中國(guó)臨床藥理學(xué)雜志;2013年07期

相關(guān)博士學(xué)位論文 前1條

1 鞠俊;建立中國(guó)兒童骨代謝標(biāo)志物正常值及探討癲癇病和抗癲癇藥物對(duì)患兒骨代謝的影響[D];中國(guó)人民解放軍醫(yī)學(xué)院;2015年

相關(guān)碩士學(xué)位論文 前1條

1 蔡青;抗癲癇藥物托吡酯對(duì)兒童骨代謝的影響[D];山東大學(xué);2008年

，

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