三种抗癫痫药物治疗BECT的疗效及对网络功能损伤和外周血NSE、GABA及MVP水平的影响  

Efficacy of three antiepileptic drugs in the treatment of BECT and their influence on network function impair⁃ment and levels of peripheral blood NSE,GABA and MVP

作　　者：路艳云 陈泽华 LU Yanyun;CHEN Zehua(Department of Pediatrics,The First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310018,China)

机构地区：[1]浙江中医药大学附属第一医院儿科,浙江杭州310018

出　　处：《全科医学临床与教育》2022年第4期311-315,共5页Clinical Education of General Practice

摘　　要：目的探讨丙戊酸(VPA)、奥卡西平(OXC)、左乙拉西坦(LEV)三种抗癫痫药物治疗伴中央颞区棘波小儿良性癫痫(BECT)的疗效及对网络功能损伤和外周血神经元特异性烯醇化酶(NSE)、γ-氨基丁酸(GABA)及主要穹窿蛋白(MVP)水平的影响。方法选择BECT患儿195例,按照随机数字表法分三组,VPA组(64例)、OXC组(65例)、LEV组(66例),给予对应抗癫痫药治疗。治疗12个月后,观察三组癫痫发作疗效、注意网络测试结果、脑电图痫样放电情况、韦氏儿童智力量表(WISC)评分以及外周血NSE、GABA及MVP水平的变化,并观察治疗期间不良反应情况。结果治疗后,三组患儿的临床治疗总有效率和脑电图痫样放电改善总有效率比较,差异均无统计学意义(χ^(2)分别=1.04、2.22,P均>0.05)。治疗后,VPA组的警觉网络、定向网络、执行控制网络时间均低于LEV组,LEV组的警觉网络、定向网络、执行控制网络时间低于OXC组(t分别=3.95、3.87、5.41;17.63、24.27、3.92,P均<0.05),VPA组、LEV组总平均反应时间低于OXC组,平均正确率高于OXC组(t分别=8.71、7.33;3.19、2.85,P均<0.05),而VPA组、LEV组总平均反应时间、平均正确率比较,差异均无统计学意义(t分别=1.77、1.06,P均>0.05)。治疗后,VPA组、LEV组言语智商(VIQ)、操作智商(PIQ)和全智商(FIQ)评分均明显高于OXC组(t分别=5.67、4.48、3.76;4.25、3.91、3.26,P均<0.05),而VPA组、LEV组比较,差异均无统计学意义(t分别=0.94、0.05、0.62,P均>0.05);VPA组的NSE水平低于LEV组,LEV组的NSE水平低于OXC组(t分别=5.94、8.49,P均<0.05),VPA组、LEV组GABA、MVP水平均低于OXC组(t分别=5.10、5.68;4.30、5.72,P均<0.05),但VPA组、LEV组GABA、MVP水平比较,差异均无统计学意义(t分别=1.05、0.00,P均>0.05)。三组治疗期间均未见明显不良反应。结论VPA、OXC、LEV三种抗癫痫药物均可减少BECT疾病发作及痫样放电,但VPA、LEV对注意网络、认知功能、血清指标的改善可�Objective To explore the efficacy of three antiepileptic drugs of valproic acid(VPA),oxcarbazepine(OXC)and levetiracetam(LEV)in the treatment of benign epilepsy with centro-temporal spikes(BECT)in children and their influence on network function impairment and levels of peripheral blood neuron-specific enolase(NSE),γ-aminobutyric acid(GABA)and major vault protein(MVP).Methods One hundred and ninety-five children with BECT were selected and divided into VPA group(64 cases),OXC group(65 cases)and LEV group(66 cases)according to the random number table method.They were treated with VPA,OXC,and LEV respectively.At 12 months after treatment,the epileptic seizure efficacy,attention network test results,electroencephalogram epileptiform discharge status,scores of Wechsler intelligence scale for children(WISC)and levels of peripheral blood NSE,GABA and MVP were observed among the three groups.The adverse reactions were observed during treatment.Results After treatment,there were no statistically significant differences in the total effective rate of clinical treatment and the total effective rate of electroencephalogram epileptiform discharge improvement among the three groups(χ^(2)=1.04,2.22,P>0.05).After treatment,the alert network time,directional network time and executive control network time in VPA group were shorter than those in LEV group,and these parameters were shorter in LEV group than OXC group(t=3.95,3.87,5.41,17.63,24.27,3.92,P<0.05),and the total average response time in VPA group and LEV group was shorter than that in OXC group,and the average correct rate was higher than that in OXC group(t=8.71,7.33,3.19,2.85,P<0.05).There were no statistical differences in the total average response time and average correct rate between VPA group and LEV group(t=1.77,1.06,P>0.05).After treatment,the scores of VIQ,PIQ and FIQ in VPA group and LEV group were higher than those in OXC group(t=5.67,4.48,3.76,4.25,3.91,3.26,P<0.05),but the differences between VPA group and LEV group were not statistically significant(t=0.

关 键 词：丙戊酸 奥卡西平 左乙拉西坦 伴中央颞区棘波小儿良性癫痫 

分 类 号：R742.1[医药卫生—神经病学与精神病学]