左乙拉西坦、拉莫三嗪与丙戊酸单药治疗初诊癫痫患者3年单药保留率及疗效的分析  

Analysis of three-year retention rate and efficacy of levetiracetam,lamotrigine and valproic acid in patients with newly diagnosed epilepsy

作　　者：齐洁 曾皎 张晓莉[1] 顾欣[1] 王福霞 罗今 顾仁骏[1] 宋景贵[1] 韩永凯[1] QI Jie;ZENG Jiao;ZHANG Xiaoli(Department of Neurologgy,the Second Affiliated Hospital of Xinxiang Medical University,Xinxiang 453002,China)

机构地区：[1]新乡医学院第二附属医院神经内科,453002

出　　处：《临床神经病学杂志》2024年第4期268-273,共6页Journal of Clinical Neurology

基　　金：2021年度新乡市科技攻关计划项目(GG2021034);2021年河南省精神心理疾病临床医学研究中心开放课题(2021-zxkfkt-013)。

摘　　要：目的 比较左乙拉西坦(LEV)、拉莫三嗪(LTG)与丙戊酸(VPA)单药治疗新诊断癫痫患者的3年单药保留率及疗效的分析。方法 根据首次选用的抗癫痫药物将323例初诊癫痫患者分为LEV组、LTG组和VPA组,通过电话及门诊对其进行≥3年的随访。结果 LEV组、LTG组、VPA组前三年单药保留率及痫样放电率差异均有统计学意义(均P<0.05)。与LEV组比较,LTG组第1年、第2年单药保留率显著降低(χ^(2)=6.265,χ^(2)=5.376;均P<0.025),痫样放电率显著升高(χ^(2)=14.011,χ^(2)=8.574;均P<0.025);VPA组第2年、第3年单药保留率显著降低(χ^(2)=6.226,χ^(2)=10.112;均P<0.025),第1年、第2年、第3年痫样放电率显著升高(χ^(2)=11.504,χ^(2)=14.206,χ^(2)=7.596;均P<0.025)。LEV组、LTG组及VPA组单药生存函数曲线及痫样放电生存函数曲线差异有统计学意义(χ^(2)=9.349,P<0.05;χ^(2)=7.395,P<0.05),LEV组单药生存函数曲线明显高于LTG组(χ^(2)=4.451,P<0.05)及VPA组(χ^(2)=9.464,P<0.05),LEV组痫样放电生存函数曲线显著低于VPA组(χ^(2)=7.523,P<0.05)。LEV组、LTG组及VPA组药物有效率、前三年单药无癫痫发作率差异无统计学意义(均P>0.05)。LEV组、LTG组、VPA组药物不良反应发生率差异有统计学意义(χ^(2)=8.068,P=0.018)。与LEV组比较,LTG组及VPA组不良反应发生率显著升高(χ^(2)=6.153,P=0.013;χ^(2)=7.109,P=0.008)。LEV组停药、添加药物和换药的主要原因为疗效不满意,LTG组及VPA组为药物不良反应。结论 LEV的3年单药保留率均高于LTG及VPA,且EEG痫样放电率及不良反应发生率均显著降低,比较适合作为初诊癫痫患者单药治疗首选药物。Objective Compared the 3-year retention rate and efficacy of levetiracetam(LEV),lamotrigine(LTG)and valproic acid(VPA)in patients with newly diagnosed epilepsy.Methods According to the antiepileptic drugs selected for the first time,323 patients with newly diagnosed epilepsy were divided into the LEV group,LTG group and VPA group.They were followed up for more than 3 years by telephone and outpatient clinic.Results There were significant differences in the single drug retention rate and epileptiform discharge rate among the LEV group,LTG group and VPA group in the first 3 years(all P<0.05).Compared with those in LEV group,the single drug retention rates in LTG group were significantly decreased in the first year and the second year(χ^(2)=6.265,χ^(2)=5.376;all P<0.025),the epileptiform discharge rate were significantly increased in the first year and the second year(χ^(2)=14.011,χ^(2)=8.574;all P<0.025);the single drug retention rate in VPA group were significantly decreased in the second year and the third year(χ^(2)=6.226,χ^(2)=10.112;all P<0.025),the epileptiform discharge rate was significantly increased in the first year,the second year and the third year(χ^(2)=11.504,χ^(2)=14.206,χ^(2)=7.596;all P<0.025).There were significant differences in the survival curve of single drug retention and epileptiform discharge among the LEV group,LTG group and VPA group(χ^(2)=9.349,P<0.05;χ^(2)=7.395,P<0.05).The survival curve of single drug retention in LEV group was significantly higher than that in LTG group(χ^(2)=4.451,P<0.05)and VPA group(χ^(2)=9.464,P<0.05).The survival curve of epileptiform discharge in LEV group was significantly lower than that in VPA group(χ^(2)=7.523,P<0.05).There was no significant difference in drug effective rate and no epileptic seizure rate in the first 3 years between LEV group,LTG group and VPA group(all P>0.05).There was a significant difference in the incidence of adverse drug reactions among the LEV group,LTG group and VPA group(χ^(2)=8.068,P=0.018).Compared with that in

关 键 词：单药保留率 抗癫痫药物 EEG 癫痫 

分 类 号：R742.1[医药卫生—神经病学与精神病学]