吡拉西坦对癫痫儿童认知功能及抗癫痫药物血药浓度的影响  

Effects of Piracetam on Cognitive Functions and Serum Antiepileptic Drugs Concentration in Epileptic Children

作　　者：王勇[1] 胡君[1] 林桂秀[1] 殷晓荣[1] 陈燕惠[1] 陈达光[1] 

机构地区：[1]福建医科大学附属协和医院儿科,福州350001

出　　处：《中国心理卫生杂志》2009年第8期549-553,共5页Chinese Mental Health Journal

基　　金：福建省卫生厅青年基金(2005-2-7)

摘　　要：目的:探讨吡拉西坦(piracetam,Pir)对癫痫儿童的认知功能以及对抗癫痫药物(antiepi-leptic drugs,AEDs)卡马西平(carbamazepine,CBZ)、丙戊酸钠(valproate,VPA)血药浓度的影响。方法:采用自身对照研究。选取2002年10月-2007年4月福建医科大学附属协和医院小儿神经专科就诊的癫痫患儿,根据发作类型分为全面性发作组、部分性发作组,分别给予丙戊酸钠、卡马西平抗癫痫治疗,最终完成临床观察的52例癫痫儿童,其中全面性发作组为24例,部分性发作组为28例,于AEDs治疗前、治疗后3个月以及Pir添加治疗后9个月进行认知功能评价和AEDs的血药浓度监测。CBZ、VPA血药浓度测定采用荧光偏振免疫分析法,采用瑞文标准推理测验和事件相关电位P300测评患儿认知功能。健康对照组23例,选自福州市中小学的健康学龄儿童,仅进行1次上述评估。结果:对照组儿童智商(IQ)高于全面性发作儿童和部分性发作儿童[(98.3±10.8)vs.(74.5±11.3),(81.5±12.0),P<0.01];抗癫痫治疗前,全面性发作儿童和部分性发作儿童P300潜伏期(P300PL)均长于对照组[(379.6±39.1)ms,(371.3±31.2)msvs.(313.5±27.6)ms,P<0.01],而波幅(P300Amp)低于对照组[(5.1±1.2)μv,(5.8±1.4)μvvs.(8.2±1.8)μv,P<0.01]。AEDs治疗3个月后全面性发作儿童和部分性发作儿童P300PL逐渐缩短,P300Amp逐渐增高趋势,其中全面性发作儿童P300PL的缩短差异有统计学意义[(379.6±39.1)msvs.(357.4±27.3)ms,P<0.01)];加用Pir9个月后全面性发作儿童和部分性发作儿童P300PL分别缩短至(333.8±29.5)ms和(341.7±28.3)ms(均P<0.01),P300Amp增高至(6.7±1.5)μv和(6.4±1.7)μv(均P<0.01);加用Pir前后癫痫儿童血清CBZ、VPA浓度和IQ差别均无统计学意义(P>0.05)。结论:Pir不影响CBZ、VPA代谢和AEDs血药浓度,但可减轻癫痫儿童认知功能损害,提高癫痫儿童的反应能力。Objective： To investigate the effects of piracetam on antiepileptic drugs （AED） valproate （VPA） and carbamazepine （CBZ） serum concentration, and the cognitive function in children with epilepsy. Methods： Altogether 52 epileptic children completed this self-control study, and among them 24 cases of generalized seizures received VPA treatment （ VPA group） and 28 cases of partial seizures received CBZ treatment （ CBZ group） . The serum levels of CBZ and VPA were tested by fluorescence polarization immunoassay （FPIA） and the cognitive function was tested with the Raven＇s standard progressive matrices （SPM） anti P300 in eventrelated potentials before AEDs therapy, 3 months after AEDs therapy, 9 months after adding piracetam. The control of 23 health children from primary and secondary schools were tested once. Results： Intelligence quotient （IQ） of the control were significantly higher than those in VPA and CBZ groups [ （98. 3 ± 10. 8 ） vs （74. 5 ± 11.3 ） and （81.5 ± 12.0）, P 〈 0. 01 ] . Before AEDs therapy, P300 latency of VPA and CBZ groups were longer than the control[ （379.6±39.1） ms and （371.3±31.2） ms vs. （313.5 ±27.6） ms, P〈0.01], and amplitude （P300Amp） werelower [ （5.1 ±1.2）μv and （5.8±1.4） μv vs. （8.2±1.8） μv, P〈0.01] .After 3 months AEDs treatment, P300 latency of VPA and CBZ groups were gradually reduced and P300Amp increased, among which the difference in P300 latency of VPA group had statistical significance [ （ 379.6 ＋ 39. 1 ） ms vs. （ 357.4 ± 27.3） ms, P 〈 0. 01 ] . AEDs treatment for 9 months after adding piracetam, P300 latency of VPA and CBZ groups were obviously reduced [ （ 333. 8 ± 29.5 ） ms vs. （ 341.7 ± 28. 3 ） ms, P 〈 0. 01 ） ] and P300Amp increased [ （6.7 ± 1.5 ） μv vs. （ 6.4 ± 1.7 ） μv, P 〈 0. 01 ] . The differences in IQ and serum levels of CBZ and VPA were not significant （P 〉0. 05 ） before and after adding piracetam. Conclusion： Piracetam can no

关 键 词：吡拉西坦 抗癫痫药物 血药浓度 智商 P300 自身对照研究 

分 类 号：R742.1[医药卫生—神经病学与精神病学]