癫痫儿童外周血p-糖蛋白水平在预测儿童抗癫痫药物疗效中的作用  

Role of peripheral P-glycoprotein in predicting efficacy of antiepileptic drugs in epilepsy children

作　　者：孔敏[1] 蒋莉[1] 洪思琪[1] 胡君[1] 叶园珍[1] 

机构地区：[1]重庆医科大学附属儿童医院神经内科,重庆400014

出　　处：《第三军医大学学报》2013年第2期153-156,共4页Journal of Third Military Medical University

基　　金：重庆市卫生局资助项目(2010-2-170)~~

摘　　要：目的检测癫痫儿童外周血p-糖蛋白(P-glycoprotein,P-gp)表达的动态变化,探讨其与癫痫耐药的关系及在预测儿童抗癫痫药物(antiepileptic drugs,AEDs)疗效中的价值。方法选取难治性癫痫患儿30例、初诊癫痫患儿40例及健康体检儿童30例,分别于入组前和治疗后6、12、18个月,用流式细胞仪检测P-gp的表达,分析P-gp表达水平与癫痫发作频率和应用AEDs抗癫痫疗效的关系。结果难治性癫痫组、初诊癫痫组在各个观察时间点P-gp表达较健康对照组均显著增高(P<0.01);难治性癫痫组各个观察时间点P-gp表达较初诊癫痫组显著增高(P<0.05);难治性癫痫组各个观察时间点P-gp的表达比较差异有显著性(P<0.01,P<0.05),初诊癫痫组各个观察时间点P-gp的表达比较差异无统计学意义(P>0.05)。难治性癫痫组入组前P-gp表达阳性19例中16例(84.2%)经换药或加药治疗无效,表达阴性11例中3例(27.3%)无效,两者比较差异有统计学意义(P<0.01);初诊癫痫组入组前P-gp表达阳性13例中9例(69.2%)转化为难治性癫痫,表达阴性27例中2例(7.4%)转化为难治性癫痫,两者比较差异有统计学意义(P<0.01)。发作频繁患儿P-gp水平明显高于发作较少患儿(P<0.01);使用4种AEDs患儿P-gp水平明显高于使用2种及3种AEDs(P<0.01)。结论癫痫患儿外周血P-gp表达升高,难治性癫痫升高更明显,可能是临床耐药的原因,可作为评价抗癫痫药物疗效的预测指标。Objective To observe the dynamic changes of the expression of P-glycoprotein （P-gp） in peripheral blood in children with epilepsy, and to explore the relationship between P-gp and epileptic resistance and its value of predicting efficacy of antiepileptic drugs （AEDs）. Methods A total of 70 inpatients and out- patients in our department from January 2011 to July 2012 were subjected in this study. These children were di- vided into refractory epilepsy （group A, n = 30, age ranging from 13 months to 15 years）, and newly diagnosed epilepsy（group B, n =40, age ranging from 2 months to 14 years）. Another 30 sex- and age-matched healthy children （ group C） served as normal control. The expression of P-gp in peripheral blood was detected by flow cytometry before treatment, and in 6, 12 and 18 months after treatment, respectively. The expression of P-gp and its relationship with epileptic frequency and therapeutic effect of AEDs were analyzed. Results The ex- pression of P-gp in group A and group B at every time point were all significantly higher than that in group C （P 〈0.01 ）, and that in group A were all significantly higher than that in group B（P 〈 0. 01 ）. Significant difference was also found in the expression of the P-gp in group A at difference time points （ P 〈 0. 01, P 〈 0.05）, but was not found in group B. Among the 19 cases with positive P-gp before treatment in group A, 16 out of them （84.2%）were invalid after changing or adding AEDs, but only 3 out of 11 cases （27.3%）with no P-gp expression became invalid, and there was a significant difference between them （P 〈 0. 01 ）. In group B, 9 out of 13 cases （69.2%）with P-gp expression before treatment became intractable, but only 2 out of 27 （7.4%） with no P-gp expression became intractable, there was a significant difference between them （P 〈0.01 ）. P-gp expression was stronger in the patients with high frequent epilepsy than those with low frequency （ P 〈 0. 01 ）. P-gp expression was also

关 键 词：癫痫 抗癫痫药物 P-糖蛋白 外周血 儿童 

分 类 号：R446.112[医药卫生—诊断学] R742.1[医药卫生—临床医学]