丙戊酸钠联用新型抗癫痫药对癫痫患儿血氨的影响  

Effect of valproic acid coadministred with new antiepileptic drugs on epileptic children's ammonia

作　　者：陈亚南[1] 张媞[1] 徐善森 刘美[1] 杨帆[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15期1378-1380,共3页The Chinese Journal of Clinical Pharmacology

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

摘　　要：目的观察丙戊酸钠(VPA)联用新型抗癫痫药(AEDs)对癫痫患儿血氨的影响。方法回顾性收集单用VPA和VPA联用托吡酯(TPM)、左乙拉西坦(LEV)、拉莫三嗪(LTG)、奥卡西平(OXC)治疗的癫痫患儿的临床资料,根据联用药物(分为VPA组、VPA+TPM组、VPA+LEV组、VPA+LTG组及VPA+OXC组)及年龄分布情况(分为VPA1组和VPA2组)对患儿进行分组,比较血氨浓度及高血氨的发生情况。结果 VPA+TPM组和VPA1组患儿的血氨浓度分别为(42.39±16.40),(36.76±16.12)μmol·L^(-1),差异有统计学意义(P<0.01);且其分别有27例(20.30%)和13例(7.56%)患儿发生高血氨,差异有统计学意义(P<0.01)。VPA+LEV组与VPA1组患儿的血氨浓度分别为(39.25±18.04),(36.76±16.12)μmol·L^(-1),差异无统计学意义(P>0.05);且其高血氨发生率分别为10.47%和7.56%,差异无统计学意义(P>0.05)。VPA+LTG组、VPA+OXC组与VPA2组患儿的血氨浓度分别为(33.22±15.70),(39.88±20.30),(34.02±17.76)μmol·L^(-1),差异无统计学意义(P>0.05);且其高血氨发生率为5.13%,9.09%,4.08%,差异无统计学意义(P>0.05)。结论 TPM能增加VPA升高血氨的风险,加重药物不良反应。临床上VPA联用TPM时,应注意监测患儿的血氨浓度,避免药物不良反应的发生。Objective To investigate the effect of valproic acid coadministred with new antiepileptic drugs （AEDs） on epileptic children＇s ammonia. Methods A retrospective analysis of clinical data of epileptic children was performed. The patients were treated with VPA only or VPA coadministred with new AEDs [ topiramate （ TPM ） , levetriracetam （LEV）, lamotrigine （LTG）, oxcarbazepine （OXC）]. We grouped these clinical data into VPA group, VPA ＋ TPM group, VPA ＋ LEV group, VPA ＋ LTG group, and VPA ＋ OXC group） according to the combined medication or VPA1 group and VPA2 group based on agedistribution, the concentration of blood ammonia and the incidence of hyperammonaemia in these children were analyzed. Results The blood ammonia in VPA ＋ TPM group was（42. 39 ± 16.40） μmol ~ L^-1 while that in VPA1 group was（36. 76 ± 16. 12） μmol · L^-1 , which showed significant difference （P 〈0. 01 ）, and there were 27 cases （20.30%）, 13 cases （7.56%） of hyperammonaemia respectively, with significant difference （P 〈 0. 01 ）. Among VPA ＋ LEV and VPA1 group, the blood ammonia were （39. 25± 18.04）, （36. 76 ± 16. 12） μmol · L^-1 , without significantdifference （P 〉 0. 05 ）, and the incidence of hyperammonaemia were 10. 47%, 7.56%, without significant difference （P〉0.05）. Among VPA ＋ LTG, VPA ＋ OXC and VPA2 group, the blood ammonia were （33.22±15.70）, （39. 88 ±20. 30）, （34. 02 ± 17.76）μmol ·L^-1, without significant difference （P 〉 0.05）; and the incidence of hyperammonaemia were 5. 13% , 9. 09%, 4. 08% , without significant difference （P 〉0.05）. Conclusion TPM can increase ammonia in children who were treated with VPA. So when VPA was coadministred with TPM, more attention should be paid to ammonia of epileptic children to avoid adverse reactions.

关 键 词：丙戊酸钠 新型抗癫痫药 血氨浓度 高血氨 

分 类 号：R971.6[医药卫生—药品]