癫痫病及抗癫痫药物对癫痫患者骨密度影响的相关性分析  

Correlation analysis between epilepsy and anti -epileptic drugs and bone mineral density of patients with epilepsy

作　　者：郭华爱[1] 毓青[1] 王凤楼[1] 杨卫东[2] 陈英[1] 陈旨娟[2] 杨二娟[1] 

机构地区：[1]天津医科大学总医院神经内科,天津300052 [2]天津医科大学总医院功能神经外科,天津300052

出　　处：《天津医科大学学报》2013年第2期140-143,共4页Journal of Tianjin Medical University

摘　　要：目的:研究癫痫病本身及抗癫痫药物(AEDs)与癫痫患者骨密度(BMD)异常的相关性。方法:采用超声法对160例年龄在20～60岁、病程≥9个月、AEDs治疗时间≥6个月的癫痫患者进行BMD检测,收集相关的临床资料并设置正常对照组50例。根据癫痫的病程、发作类型、服用AEDs的数量及种类、治疗时间分组,分析各组临床指标与骨量异常的相关性。结果:癫痫患者组BMD异常率与正常对照组比较有显著差异(P<0.01)。全面强直阵挛性发作(GTCS)、AEDs多药治疗及治疗时间与BMD异常显著相关(P<0.05);病程、肝酶诱导性与非肝酶诱导性AEDs对骨量的影响各组内比较差异无显著性(P>0.05)。多因素分析显示发作类型、AEDs服药数量及治疗时间为癫痫患者BMD降低的独立危险因素(P<0.05),其OR值分别为1.105,5.710,5.820。结论:癫痫病本身及抗癫痫药物均对癫痫患者骨密度有影响,其中GTCS、AEDs多药治疗及长期服用AEDs是癫痫患者发生BMD异常的主要危险因素,故应积极控制癫痫发作尤其是GTCS,避免不必要的多药联合治疗,从而有效预防癫痫患者的骨量改变,防止骨折的发生。Objective： To investigate the effects of epilepsy and anti-epileptic drugs（AEDs） on bone mineral density（BMD） of patients with epilepsy. Methods： 160 cases aged between 20 and 60 years old were selected as subjects. All of them had the disease for more than nine months and had been taking AEDs for more than six months. All were free of other diseases and none was taking any medica- tion that might interfere with bone metabolism other than AEDs. BMDs at the right heel were measured with the ultrasonic BMD instru- ment. Detailed clinical information of each patient were obtained by the researcher. All of the related risk factors in the data were strati- fied according to certain degree. Fifty normal controls were involved. Then single factor chi-square test and multivariate logistic regres- sion analysis were analyzed. Results： There was statistically significant difference between epileptics and normal group in BMD （P〈0.01）. Single factor chi-square test revealed that generalized tonic-clonic seizure （GTCS）, polypharmacy and the duration of anticonvulsant therapy were significantly correlated with BMD （P〈0.05）. None of the course of epilepsy, hepatic enzyme-inducing and -noninducing AED was significantly associated with low BMD （P〉0.05）. Multivariate logistic regression analysis identified GTCS,polytherapy and the duration of anticonvulsant therapy were as the related and independent risk factors（OR value, 1.105, 5.710, 5.820, respectively; P〈0.05）. Conclusion： The results indicate that both epilepsy and anti-epileptic drugs can lead to the change of BMD of patients with epilepsy, and GTCS, polytherapy and the duration of anticonvulsant therapy are important risk factors of low BMD. It can be used as valuable reference to prevent bone mass loss and fractures of epileptic patients effectively.

关 键 词：癫痫 抗癫痫药 骨密度 危险因素 

分 类 号：R742.1[医药卫生—神经病学与精神病学]