丙戊酸治疗癫痫患儿诱发高氨血症的危险因素分析  

Risk factors for hyperammonemia associated with valproic acid therapy in epileptic children

作　　者：张媞[1] 徐善森 杨帆[1] 陈亚南[1] 肇丽梅[1] 

机构地区：[1]中国医科大学附属盛京医院药学部,沈阳110004

出　　处：《中国临床药理学杂志》2016年第4期363-365,共3页The Chinese Journal of Clinical Pharmacology

基　　金：国家自然基金资助项目(81302857);辽宁省自然科学基金资助项目(2013021079)

摘　　要：目的观察血氨对癫痫患儿肝功能的影响,以及丙戊酸(VPA)诱发高氨血症的危险因素。方法将236例单用丙戊酸的癫痫患儿按血氨水平分为高血氨组(HG)40例、血氨异常组(AG)96例、对照组(CG)100例。用K-独立样本非参数检验方法考查血氨与患儿肝功能情况的相关性。通过Logistic回归分析年龄、性别、体重、日剂量、丙戊酸浓度对丙戊酸诱发高氨血症的危险。结果 HG组、AG组和CG组分别有25例(62.5%)、42例(43.8%)、43例(43.0%)患儿肝功能指标超出参考值范围,分别有5例(12.5%)、7例(7.3%)、2例(2.0%)患儿出现肝损伤。HG组的肝损伤患儿分布频率显著高于AG组和CG组(P<0.05)。Logistic回归结果显示,年龄(小)、日剂量(大)、丙戊酸浓度(高)是丙戊酸诱发高氨血症的危险因素。结论癫痫患儿在使用丙戊酸治疗时,应关注体内血氨浓度,在病情控制良好的情况下,及时调整用药剂量和血药浓度,避免高血氨的发生。Objective To investigate the effects of ammonia on liver function in children with epilepsy,and the risk factors of valproic acid（ VPA）- induced hyperammonemia. Methods The total of 236 cases of epileptic children with VPA monotherapy were divided into three groups,hyperammonemia group（ HG,40 cases）,abnormal group（ AG,96 cases） and control group（ CG,100 cases）. The K- nonparametric test for independent sample method was used to determine the correlation between the ammonia and the liver function of epileptic children. Logistic regression method was used to analyze the risk factors,such as age,gender,weight,dosage,concentration of VPA,of VPA induced to hyperammonemia. Results Among the three groups,the liver function of 25 cases（ 62. 5%）,42 cases（ 43. 8%）,43 cases（ 43. 0%） were beyond the reference range respectively,and there were 5 cases（ 12. 5%）,7 cases（ 7. 3%）,2 cases（ 2. 0%） appeared liver injury respectively. The frequencies of epileptic children with liver injury in HG was significantly higher than that in AG and CG（ P〈0. 05）. Logistic regression showed that age（ small）,the daily dose（ big）,the concentration of VPA（ high）were the risk factors of VPA induced hyperammonemia.Conclusion When the epileptic children were treated with VPA monotherapy,the concentration of ammonia in vivo should be concerned. Wecould adjust the dose and plasma concentration of VPA to avoid the occurrence of hyperammonemia in well- controlled children.

关 键 词：丙戊酸 高氨血症 癫痫 危险因素 

分 类 号：R971.6[医药卫生—药品] R742.1[医药卫生—药学]