抗癫痫发作药物促使癫痫共病抑郁的影响因素研究  

Use of anti-seizure medications links to an increased risk of comorbid depression in patients with epilepsy

作　　者：胡子寒 邵志海 彭伟锋 HU Zihan;SHAO Zhihai;PENG Weifeng(Department of Neurology,Zhongshan Xiamen Hospital,Fudan University,Xiamen 361015,China;Department of Neurology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Neurology,Shanghai Geriatric Medical Center,Shanghai 201104,China)

机构地区：[1]复旦大学附属中山医院厦门医院神经内科,厦门361015 [2]复旦大学附属中山医院神经内科,上海200032 [3]上海市老年医学中心神经内科,上海201104

出　　处：《中国临床药学杂志》2025年第1期39-44,共6页Chinese Journal of Clinical Pharmacy

基　　金：福建省卫健委科技计划项目(编号2021GGB033)。

摘　　要：目的 探究抗癫痫发作药物(ASMs)促使癫痫共病抑郁的影响因素。方法 纳入2018年2月至2022年6月就诊的癫痫病例308例,根据17项汉密尔顿抑郁量表(HAMD-17)评分分为抑郁组(HAMD-17得分≥7,n=115)和非抑郁组(HAMD-17得分<7,n=193)。收集病例的人口学资料、癫痫发作情况和ASMs使用情况。采用HAMD-17评估抑郁严重程度,采用匹兹堡睡眠质量指数(PSQI)和Epworth嗜睡量表(ESS)分别评估睡眠质量和日间嗜睡情况。以二元Logistic回归分析ASMs促使癫痫共病抑郁的影响因素。结果 抑郁组近1年癫痫发作频率、应用苯二氮?类药物的病例数占比、多种ASMs联用的病例数占比和存在睡眠障碍的病例数占比均高于非抑郁组(P<0.05)。在调整混杂因素的影响后,抑郁组多种ASMs联用的病例数占比、使用苯二氮?类药物的病例数占比和存在睡眠障碍的病例数占比仍高于非抑郁组(P<0.05)。二元Logistic回归分析显示,多种ASMs联用(OR=2.56,95%CI 1.46~4.48,P=0.001)和存在睡眠障碍(OR=9.01,95%CI 4.77~16.99,P<0.001)是ASMs促使癫痫共病抑郁的独立危险因素。结论 多种ASMs联用(特别是包含苯二氮?类药物)和存在睡眠障碍是癫痫共病抑郁的独立危险因素,在临床中应注重对此类患者治疗过程中情绪障碍的筛查和诊治。AIM To investigate the independent risk factors of anti-seizure medication use contributing to the condition of comorbid depression in patients with epilepsy. METHODS A total of 308 epilepsy patients diagnosed between February 2018 and June 2022 were recruited in the study. According to the 17-item Hamilton Depression Rating Scale(HAMD-17), patients were categorized into the depression group(HAMD-17 score ≥ 7, n=115) and non-depression group(HAMD-17score < 7, n=193). Demographic data, seizure-associated variables, and types of ASMs used were prospectively collected from the recruited patients. Depression was assessed using the HAMD-17. In addition, the Pittsburgh Sleep Quality Index(PSQI)and Epworth Sleepiness Scale(ESS) were used to evaluate subjective sleep quality and daytime sleepiness. Additionally, the binary logistic regression analyses were conducted to determine the influencing factors of comorbid depression due to ASMs.RESULTS The percentages of patients with benzodiazepine use, polytherapy of ASMs and poor sleep quality and seizure frequency in the last year were all significantly higher in the depression group compared to the non-depression group(P < 0.05).The proportion of patients using multiple ASMs, benzodiazepines, and those with poor sleep quality remained significantly higher in the depression group compared to the non-depression group after adjusting for potential confounding factors. The binary logistic regression analysis showed that polytherapy(OR=2.56, 95% CI 1.46-4.48, P=0.001) and poor sleep quality(OR=9.01, 95% CI 4.77-16.99, P < 0.001) were independent risk factors for ASMs contributing to depression in patients with epilepsy. CONCLUSION Polytherapy of ASMs(especially containing benzodiazepine) and poor sleep quality are independent risk factors for comorbid depression in patients with epilepsy. In clinical practice, it is crucial to focus on screening and diagnosing emotional disorders during the treatment process for the patients.

关 键 词：癫痫 抗癫痫发作药物 抑郁 共病 睡眠障碍 

分 类 号：R971[医药卫生—药品]