丙戊酸钠治疗与胰岛素抵抗  

Insulin resistance in epileptic patients during treatment of valproic acid

作　　者：丁美萍[1] 包颖颖[1] 陈忠[1] 刘志蓉[1] 徐珑珑[1] 

机构地区：[1]浙江大学医学院附属第二医院,浙江杭州310009

出　　处：《浙江大学学报（医学版）》2004年第3期216-218,共3页Journal of Zhejiang University(Medical Sciences)

摘　　要：目的 :探讨丙戊酸钠治疗的癫痫患者体重指数和胰岛素水平 ,以及胰岛素抵抗的变化。方法 :测定 4 3例单一丙戊酸钠治疗和 39例单一卡马西平治疗 2年以上癫痫患者的体重、空腹血糖、空腹胰岛素水平 ,比较两组的体重指数 ( BMI)和稳态模式评估 ( HOMA)指数。结果 :丙戊酸钠组的 BMI( 2 3.4 7± 1.4 5 )、胰岛素 ( 6 .6 4± 0 .79)m U/ L、HOMA指数 ( 1.33± 0 .2 1)均明显高于卡马西平治疗组 [分别为 ( 2 2 .2 7± 2 .10 ) ,P<0 .0 5 ;( 5 .5 2± 0 .5 2 )m U/ L,P<0 .0 1;( 1.15± 0 .12 ) ,P<0 .0 1],而两组的空腹血糖水平无统计学差异 ( P>0 .0 5 ) ;BMI与丙戊酸钠剂量、血药浓度均无相关性 (分别 r=0 .16、0 .0 2 )。结论 :丙戊酸钠能引起体重增加和高胰岛素血症 ,导致胰岛素抵抗 ,影响机体的内分泌和代谢功能。Objective: To investigate the possible role of valproic acid therapy in the development of the weight gain and hyperinsulinemia of epileptic patients. Methods: The weight and fasting insulin levels were measured in 43 epileptic patients treated with valproic acid (VPA) alone and 39 patients with carbamazepine(CBZ) alone for at last 2 years. The body mass index (BMI) and homeostasis model assessment (HOMA) index were studied in the two groups. Results: BMI was higher in the VPA-treated group (23 47±1 45) than that in the CBZ-treated group (22 27±2 10, P <0 05). Fasting insulin level and HOMA index in the VPA group were also higher [(6 64±0 79)mU/L and 1 33±0 21] than those in the CBZ group [(5 52±0 52)mU/L, P <0 01; 1 15±0 12, P <0 01]. While BMI in the VPA group showed no significant correlation with plasma concentration and dose of valproate. Conclusion: VPA therapy is associated with significantly greater weight gain and hyperinsulinemia, suggesting development of insulin resistance.

关 键 词：抗癫痫药/副作用 丙戊酸钠/副作用 血糖 胰岛素/血液 体重指数 胰岛素抵抗指数 

分 类 号：R742.1[医药卫生—神经病学与精神病学]