拉莫三嗪单药治疗老年癫痫患者有效性及耐受性的Meta分析  

A meta-analysis of monotherapy of lamotrigine versus carbamazepine in the elderly patients

作　　者：吴蕾[1] 胡世莲[1] 陈尹[2] 徐婷娟 徐维平[2] 任明山[1] 李淮玉[1] 沈干 

机构地区：[1]安徽医科大学附属省立医院安徽省立医院,合肥230001 [2]安徽省循证医学中心 [3]安徽省老年病研究所

出　　处：《中国临床保健杂志》2010年第1期27-29,共3页Chinese Journal of Clinical Healthcare

基　　金：安徽省卫生厅基金资助(2008A052)

摘　　要：目的系统评价60岁及其以上人群应用拉莫三嗪（LTG）单药治疗癫痫的控制率及耐受性。方法参照Cochrane癫痫组制定的检索策略，计算机全面检索Cochrane癫痫组登记的随机对照试验库（CCTR），pubmed，中国生物医学数据库和中国循证医学中心RCT／CCT数据库等资料库并追踪检索相关的综述、论文的参考文献。采用退出治疗率、癫痫缓解率、副作用发生情况作为观察指标。结果共检索到7个符合纳入标准的临床试验，4个涉及到英国、法国、克罗地亚、芬兰、挪威等至少49个中心的包括797例患者随机对照试验纳入本次分析，所有治疗时间均超过3个月。Meta分析结果显示：（1）拉莫三嗪与卡马西平均能较好控制老年人群的癫痫发作，两组在控制率方面差异无统计学意义（P=0．53，OR值为1．29，95％CI0．59～2．81）；（2）两组患者均出现较多的不适主诉，拉莫三嗪组和卡马西平完成治疗的人数有显著性差异（P=0．003，OR：2．37，95％CI1．34—4．19），拉莫三嗪组患者因副作用退出率较卡马西平组明显减少（OR：0．33，95％CI0．23～0．49，P〈0．01）；（3）拉莫三嗪组镇静作用较卡马西平组显著减轻（OR：0．66，95％CI0．47—0．93，P=0．02）。所有试验没有针对不同发作类型亚组老年人群的研究资料。结论老年癫痫患者单药应用拉莫三嗪在控制发作方面与常规一线用药卡马西平没有差异，但较卡马西平组显示出较好的耐受性。两种药物均显示出较高比例的神经系统及全身不适的事件发生率。Objective To compare the effects and tolerance of lamotrigine and carbamazepine monotherapy for the 60 years old patients with epilepsy. Methods A meta-analysis using data from randomized trials comparing lamotrigine with carbamazepine monotherapy. The review draws on the search strategy developed for the Cochrane Epilepsy Group,which searches pubmed and the Cochrane Controlled Trials Register, Chinese Medicine database, Chinese Cochrane Centre Database of Clinical Trials and Diagnostic Tests and hand searches the revelent references. The primary outcomes were the rate of seizure free, withdrawal and the adverse effects. Results Seven clinical trials were searched and four randomized trials were included containing data for 794 participants from at least 39 medical center. （1） There was no signnificant differences on the ratio of seizure seizure freedom（ P = 0.53, OR 1.29,95% CI 0.59 - 2.81, random effects ） ;（ 2 ）Considerable complaines were reported in both groups, while the number of finished treatment with lamotrigine is higher than earbamazepine （ P = 0. 003, OR 2.37,95 % CI 1. 34 - 4.19 random effects ）. The number of withdrawal for adverse effect significantly decreased with lamotrigine compared to carbamazepine （ P 〈 0.01 ,OR：0.33,95% CI 0.23 - 0.49, random effects） ; （ 3 ） The number suffered with sedation with lamotrigineis is lower than the carbamazepine （ OR ：0.66,95 % CI 0.47 - 0.93, P = 0.02 ）. There is no data on subgroups of partial or generalized seizure. Conclusions Lamotrigine could control the seizure in the elderly patients and is significantly less likely to be withdrawn than carbamazepine.

关 键 词：癫痫 钠通道阻滞剂 药物毒性 药物耐受性 META分析 老年人 

分 类 号：R742.1[医药卫生—神经病学与精神病学]