张景杰;蔡西国;

• 1:商丘市第三人民医院
• 2:河南省人民医院

摘要(Abstract)：

目的研究颅脑损伤后继发性癫痫的患儿接受丙戊酸钠联合左乙拉西坦治疗的临床效果,并探讨对神经保护作用和炎症因子白细胞介素-6(IL-6)、高敏C反应蛋白(hs-CRP)的影响。方法纳入2014-01—2019-02商丘市第三人民医院收治的87例颅脑损伤后继发性癫痫患儿,对照组43例,联合组44例,对照组给予丙戊酸钠治疗,联合组给予丙戊酸钠和左乙拉西坦的联合治疗,比较2组临床治疗效果、炎症因子白细胞介素-6(IL-6)、高敏C反应蛋白(hs-CRP)水平变化及神经功能改善情况。结果联合组治疗总有效率90.91%,高于对照组的76.74%,组间对比差异有统计学意义(P<0.05);联合组治疗6个月后IL-6、hs-CRP水平低于对照组,差异有统计学意义(P<0.05);联合组治疗3个月、6个月后神经功能评分分别为(17.55±4.02)分、(13.65±3.29)分,均低于对照组的(20.19±4.27)分、(16.67±3.74)分,组间比较差异有统计学意义(P<0.05)。结论小儿颅脑损伤后继发性癫痫给予丙戊酸钠联合左乙拉西坦治疗能够更明显降低炎症因子水平,改善患儿神经功能,提升整体治疗有效性。

关键词(KeyWords)： 丙戊酸钠;左乙拉西坦;小儿颅脑损伤;继发性癫痫;炎症因子;神经功能

Abstract:

Keywords:

基金项目(Foundation): 河南省医学科技攻关计划项目（编号：2017T02057）

作者(Authors): 张景杰;蔡西国;

参考文献(References)：

• [1] KERET A,BENNETT-BACK O,ROSENTHAL G,et al. Posttraumatic epilepsy:long-term follow-up of children with mild traumatic brain injury[J]. J Neurosurg Pediatr,2017,20(1):64-70. DOI:10.3171/2017.2.PEDS16585.
• [2] GOMES D,PIMENTEL J,BENTES C,et al.Consensus Protocol for the Treatment of Super-Refractory Status Epilepticus[J]. Acta Med Port,2018,31(10):598-605. DOI:10.20344/amp.9679.
• [3] ZHAO J,SANG Y,ZHANG Y,et al. Efficacy of levetiracetam combined with sodium valproate on pediatric epilepsy and its effect on serum miR-106b in children[J]. Exp Ther Med,2019,18(6):4436-4442. DOI:10.3892/etm.2019.8098.
• [4]刘方，张敏，刘恒方，等.丙戊酸钠干预对癫痫鼠模型海马区B1及B2受体表达的影响[J].中国实用神经疾病杂志，2020,23(24):2130-2133.DOI:10.12083/SYSJ.2020.16.020.
• [5] NEVITT S J,MARSON A G,WESTON J,et al.Sodium valproate versus phenytoin monotherapy for epilepsy:an individual participant data review[J]. Cochrane Database Syst Rev,2018,8(8):CD001769. DOI:10.1002/14651858.CD001769.pub4.
• [6] ZAGAJA M,HARATYM-MAJ A,SZEWCZYK A,et al. Levetiracetam combined with ACEA,highly selective cannabinoid CB1 receptor agonist changes neurogenesis in mouse brain[J]. Neurosci Lett,2019,696:79-86. DOI:10.1016/j.neulet.2018.12.016.
• [7] CHARTRAIN A G,YAEGER K,FENG R,et al. Antiepileptics for Post-Traumatic Seizure Prophylaxis after Traumatic Brain Injury[J].Curr Pharm Des,2017,23(42):6428-6441.DOI:10.2174/1381612823666171031100139.
• [8] ZHANG Z,ZHAO D H,ZHAO X T,et al.Levetiracetam administration is correlated with lower mortality in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes:a retrospective study[J].Chin Med J(Engl),2019,132(3):269-274.DOI:10.1097/CM9.0000000000000061.
• [9] GREENHALGH J,WESTON J,DUNDAR Y,et al. Antiepileptic drugs as prophylaxis for postcraniotomy seizures[J]. Cochrane Database Syst Rev,2018,5(5):CD007286. DOI:10.1002/14651858.
• [10] LIU Z,LI J,YANG F,et al. Sodium valproate combined with levetiracetam in pediatric epilepsy and its influence on NSE,IL-6,hs-CRP and electroencephalogram improvement[J].Exp Ther Med,2020,20(3):2043-2048. DOI:10.3892/etm.2020.8916.
• [11] LIGUORI C,TURNER K,IZZI F,et al. Preliminary evidence about irritability in patients with epilepsy treated by perampanel as first add-on therapy compared to levetiracetam and valproic acid[J]. CNS Neurosci Ther,2019,25(5):632-637. DOI:10.1111/cns.13098.
• [12] LIAMPAS I,SIOKAS V,BROTIS A,et al. Intravenous sodium valproate in status epilepticus:review and Meta-analysis[J]. Int J Neurosci,2020,2:1-15. DOI:10.1080/00207454.2020.1732967.
• [13] KNIGHTS M J,FINLAY E. The effects of sodium valproate on the renal function of children with epilepsy[J]. Pediatr Nephrol,2014,29(7):1131-1138. DOI:10.1007/s00467-013-2512-x.
• [14]马新强，赵默，甄恩迪，等.丙戊酸钠联合托吡酯对部分发作性癫痫患儿的临床疗效分析[J].中国实用神经疾病杂志，2020,23(15):1318-1322. DOI:10.12083/SYSJ.2020.15.018.
• [15]钱国红，李丽，李静.癫痫患者疾病感知与心理弹性水平的相关性[J].中国实用神经疾病杂志，2021,24(1):88-92.DOI:10.12083/SYSJ.2021.06.017.
• [16] PINDER R M,BROGDEN R N,SPEIGHT T M,et al. Sodium valproate:a review of its pharmacological properties and therapeutic efficacy in epilepsy[J]. Drugs,1977,13(2):81-123.DOI:10.2165/00003495-197713020-00001.
• [17] KORISTKOVA B,GRUNDMANN M,BROZMANOVA H,et al. Lamotrigine drug interactions in combination therapy and the influence of therapeutic drug monitoring on clinical outcomes in paediatric patients[J]. Basic Clin Pharmacol Toxicol,2019,125(1):26-33.DOI:10.1111/bcpt.13203.
• [18] HAPPOLD C,GORLIA T,CHINOT O,et al.Does Valproic Acid or Levetiracetam Improve Survival in Glioblastoma? A Pooled Analysis of Prospective Clinical Trials in Newly Diagnosed Glioblastoma[J]. J Clin Oncol,2016,34(7):731-739. DOI:10.1200/JCO.2015.63.6563.
• [19] CONTIN M,BISULLI F,SANTUCCI M,et al.Perampanel Study Group.Effect of valproic acid on perampanel pharmacokinetics in patients with epilepsy[J]. Epilepsia,2018,59(7):e103-e108. DOI:10.1111/epi.14446.
• [20] DU Y,LIN J,SHEN J,et al. Adverse drug reactions associated with six commonly used antiepileptic drugs in southern China from 2003to 2015[J]. BMC Pharmacol Toxicol,2019,20(1):7. DOI:10.1186/s40360-019-0285-y.
• [21] STEPHEN L J,BRODIE M J. Pharmacological Management of the Genetic Generalised Epilepsies in Adolescents and Adults[J]. CNS Drugs,2020,34(2):147-161. DOI:10.1007/s40263-020-00698-5.
• [22]王葆辉，耿丽娟，刘俊.癫痫小儿认知功能与血清蛋白激酶C表达水平的相关性分析[J].中国实用神经疾病杂志，2021,24(7):602-608.DOI:10.12083/SYSJ.2021.02.012.
• [23] LAWTHOM C. Valproate and epilepsy:for women as well as men[J]. Pract Neurol,2018,18(3):222-223. DOI:10.1136/practneurol-2018-001931.
• [24] BALAGURA G,IAPADRE G,VERROTTI A,et al. Moving beyond sodium valproate:choosing the right anti-epileptic drug in children[J].Expert Opin Pharmacother,2019,20(12):1449-1456. DOI:10.1080/14656566.2019.1617850.
• [25] MEENU M,REETA K H,DINDA A K,et al.Evaluation of sodium valproate loaded nanoparticles in acute and chronic pentylenetetrazole induced seizure models[J]. Epilepsy Res,2019,158:106219. DOI:10.1016/j.eplepsyres.2019.106219.
• [26] SU L J,WANG Y L,HAN T,et al.Antimyoclonic Effect of Levetiracetam and Clonazepam Combined Treatment on Myoclonic Epilepsy with Ragged-Red Fiber Syndrome with m.8344A>G Mutation[J].Chin Med J(Engl),2018,131(20):2433-2438. DOI:10.4103/0366-6999.243568.
• [27] FAUGHT E,HELMERS S,THURMAN D,et al.Patient characteristics and treatment patterns in patients with newly diagnosed epilepsy:A US database analysis[J].Epilepsy Behav,2018,85:37-44. DOI:10.1016/j.yebeh.2018.05.019.
• [28] LINDER C,NEIDEMAN M,WIDE K,et al.Dried Blood Spot Self-Sampling by Guardians of Children With Epilepsy Is Feasible:Comparison With Plasma for Multiple Antiepileptic Drugs[J]. Ther Drug Monit,2019,41(4):509-518. DOI:10.1097/FTD.0000000000000605.
• [29] BRIANT R H,FOOTE S E,WALLIS W E. Sodium valproate(Epilim)in epilepsy:a trial[J]. N Z Med J,1978,88(626):479-482.
• [30] KHAN S A,BHATTI S N,KHAN A A,et al.Comparison Of Efficacy Of Phenytoin And Levetiracetam For Prevention Of Early Post Traumatic Seizures[J]. J Ayub Med Coll Abbottabad,2016,28(3):455-460.
• [31] O'NEILL B R,HANDLER M H,TONG S,et al. Incidence of seizures on continuous EEG monitoring following traumatic brain injury in children[J]. J Neurosurg Pediatr,2015,16(2):167-176. DOI:10.3171/2014.12.PEDS14263.
• [32] HOLMES G L. Seizure-induced neuronal injury:animal data[J]. Neurology,2002,59(9 Suppl 5):S3-S6. DOI:10.1212/wnl.59.9_suppl_5.s3.
• [33] SINGER R B. Incidence of seizures after traumatic brain injury--a 50-year population survey[J]. J Insur Med,2001,33(1):42-45.