抗癫痫药物及其他危险因素对妊娠癫痫妇女及胎儿的影响  

The effects of the anti-epilepsy drugs and other risk factors on the pregnant women with epilepsy and their fetus

作　　者：杨宁[1] 黎冰梅[1] 刘晓蓉[1] 邓宇虹[1] 于美娟[1] 廖卫平[1] 

机构地区：[1]广州医学院第二附属医院神经内科,广州510260

出　　处：《国际医药卫生导报》2010年第4期385-388,共4页International Medicine and Health Guidance News

基　　金：基金项目：广东省科技计划项目（2005834201001）广州医学院归国人员启动基金（2008C14）

摘　　要：目的 对抗癫痫药物及其他危险因素对妊娠癫痫妇女及胎儿的影响进行前瞻性研究。方法 （1）癫痫妇女孕早期或妊娠前咨询入组。（2）孕期主要观察指标：对高危患者进行检查，包括血浆中AFP的水平、染色体检查、羊水穿刺细胞学及分子生物学检查、分子遗传分析、B超等。（3）畸形的确认：根据国际疾病控制中心编写的严重先天性缺陷一览表（1998年修订）。（4）危险因素分析：妊娠年龄、畸形的家族史、吸烟、饮酒、单用或联用抗癫痫药物、抗癫痫药物剂量、癫痫的分型、妊娠前3月内癫痫发作频率等。结果 共入组57例妊娠癫痫妇女，共有41例 妊娠癫痫妇女顺利生产，其中29例患者生产并随访1年或以上，其他 12例患者生产后随访不足1年，仅有一例新生儿死亡且无明显先天性畸形 （占2.44%），其他的新生儿均无先天性畸形。这些已生产的妊娠癫痫妇女在怀孕期间服用较低剂量的抗癫痫药物，卡马西平用量200～700mg/d，丙戊酸钠250～750 mg/d，托吡酯37.5～150 mg/d，奥卡西平450 mg/d，拉莫三嗪62.5～150 mg/d，氯硝安定2～4 mg/d。新生儿死亡的孕妇服用卡马西平300 mg/d。结论 本组妊娠癫痫妇女按照癫痫发作类型和癫痫综合征类型服用较低剂量的抗癫痫药物，并在专科医师的指导下和长期随访情况下用药，没有出现先天性畸型新生儿。这一方面可能是在专科医师指导下使用致畸性小的抗癫痫药物的结果，亦有可能是观察病例数不够多的原因，提示该项目研究应该持续进行。Objective To conduct a prospective study on the effects of the anti-epilepsy drugs and other risk factors on the pregnant women with epilepsy and their fetus. Methods （1） Women with epilepsy were included before pregnancy or at early stage of pregnancy. （2） In order to detect the high risk patients, AFP, chromosome examination, Amniotic Fluid Cytological Test and molecular biological test, type-B ultrasonic test were done. （3） Identifica tion of congenital malformation： according to the list of severe congenital birth defects （International Centers for Disease Control, revised 1998）. （4）Risk factors： age of pregnancy, family history of malformation, smoke, drunk, monotherapy /polytherapy of antiepileptic drugs （AEDs）, dosage of AEDs, types of seizure, seizure frequency in early three months of pregnancy and through whole pregnancy.Results Fifty-seven pregnant women with epilepsy were included, there were 41 live births, only 1 newborn died 6 hours later after birth without congenital malformation （ 1/41,2.4% ）, other 40 babies were without congenital malformation . The dosage of antiepileptic drugs taken by the pregnant women with epilepsy were carbamazepine 0.2-0.7/day, valproate 0.25-0.75/day, topiramate 37.5-150mg/day,oxcarbazepine450mg/day, lamotrigine62.5-150mg/day,Clonazepam 2mg-4mg/day. The pregnant women with epilepsy who had a baby with perinatal mortality took carbamazepine 0.3/day. Conclusion The pregnant women with epilepsy in our study took the relatively small dosage of antiepileptic drugs according to the seizure types, there were no congenital malformation in the newborns, it may be the low dosage and types of antiepileptic drugs leading to low risk of congenital malformation, it also may suggest that the sample size was too small that future research should seek to determine the exact teratogenic risks attributable to each individual AED and to delineate the mechanisms underlying AED-induced teratogenesis.

关 键 词：癫痫 抗癫痫药物 妊娠 先天畸形 胎儿 

分 类 号：R742.1[医药卫生—神经病学与精神病学]