小剂量丙戊酸钠对双相情感障碍患者认知功能的影响及安全性研究  

The Effect and Safety of Low-dose Sodium Valproate on Cognitive Function in Patients with Bipolar Disorder

作　　者：李昱 张应 付艳梅 Li Yu;Zhang Ying;Fu YanMei(Mental Health Center of Enshizhou Youfu Hospitai,Enshi,Hubei,445000,China)

机构地区：[1]恩施州优抚医院精神卫生中心,湖北恩施445000

出　　处：《哈尔滨医药》2025年第2期33-36,共4页Harbin Medical Journal

摘　　要：目的探讨小剂量丙戊酸钠对双相情感障碍(BPD)患者认知功能的影响及安全性。方法选取BPD患者115例进行回顾性研究,按丙戊酸钠不同治疗剂量设A、B、C组,各为40、40、35例。A组给予10mg/kg丙戊酸钠治疗,B组给予15mg/kg丙戊酸钠治疗,C组给予20mg/kg丙戊酸钠治疗。比较三组一般资料及临床疗效,同时检测其血药浓度相关指标(平均血药浓度、达稳态血药浓度阈值时间),另外评估三组杨氏躁狂评定量表(YMRS)、蒙特利尔认知评估量表(MoCA)评分及肝功能指标[丙氨酸氨基转移酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)]水平,最后比较其不良反应。结果三组总有效率差异无统计学意义(P>0.05);三组平均血药浓度差异无统计学意义(P>0.05);较A组,B、C组达稳态血药浓度谷值时间均更短(P<0.05);采用多元性线性回归矫正三组基线数据,治疗前、治疗后2个月,三组MoCA、YMRS评分相当(P>0.05);三组治疗后2个月,较治疗前,YMRS评分均降低,MoCA评分均升高(P<0.05);治疗前,三组肝功能水平差异无统计学意义(P>0.05);三组治疗后2个月,较治疗前,肝功能水平均升高,且A组更低(P<0.05);较B、C组(17.50%、31.43%),A组不良反应总发生率7.50%更低(P<0.05)。结论10、15、20mg/kg的丙戊酸钠用于治疗BPD临床效果相当,均可改善患者躁狂、抑郁症状及认知功能。但10mg/kg的丙戊酸钠对患者肝功能影响最小,安全性较高。Objective To investigate the effect and safety of low-dose valproate on cognitive function in patients with bipolar disorder(BPD).Methods A retrospective study was conducted on 115 patients with BPD.Groups A,B,and C were set up according to different treatment doses of sodium valproate,with 40,40,and 35 patients in each group.Group A received 10mg/kg valproate,Group B 15mg/kg valproate and Group C 20mg/kg valproate.Comparing three groups of general data and clinical efficacy,test the plasma concentration related indicators(mean plasma concentration,steady state plasma concentration trough time),and evaluate the three groups of young manic rating scale(YMRS),the Montreal cognitive assessment scale(MoCA)score and liver function indicators[alanine aminotransferase(ALT),glutamase aminotransferase(AST),total bilirubin(TBIL)]level,and finally compare the adverse reactions.Results The total effective rates of the three groups were comparable(P>0.05);The average blood drug concentrations of the three groups were comparable(P>0.05);Compared with group A,groups B and C had shorter time to reach the steady-state blood drug concentration trough(P<0.05);Multiple linear regression was used to correct the baseline data of three groups.Before treatment and 2 months after treatment,the MoCA and YMRS scores of the three groups were comparable(P>0.05);Two months after treatment,YMRS scores decreased and MoCA scores increased in all three groups compared to before treatment(P<0.05);Before treatment,the liver function levels of the three groups were comparable(P>0.05);Two months after treatment,the liver function levels of all three groups increased compared to before treatment,and group A had a lower level(P<0.05);Compared with groups B and C(17.50%,31.43%),group A had a lower overall incidence of adverse reactions at 7.50%(P<0.05).Conclusion 10mg/kg,15mg/kg,20mg/kg and 20 mg/kg of BPD can improve manic and depressive symptoms and cognitive function.However,10mg/kg of valproate had the least effect on liver function and had high saf

关 键 词：丙戊酸钠 双相情感障碍 认知功能 安全性 肝功能 

分 类 号：R749.4[医药卫生—神经病学与精神病学]