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目的观察丙戊酸钠(VPA)联用新型抗癫痫药(AEDs)对癫痫患儿血氨的影响。方法回顾性收集单用VPA和VPA联用托吡酯(TPM)、左乙拉西坦(LEV)、拉莫三嗪(LTG)、奥卡西平(OXC)治疗的癫痫患儿的临床资料,根据联用药物(分为VPA组、VPA+TPM组、VPA+LEV组、VPA+LTG组及VPA+OXC组)及年龄分布情况(分为VPA1组和VPA2组)对患儿进行分组,比较血氨浓度及高血氨的发生情况。结果 VPA+TPM组和VPA1组患儿的血氨浓度分别为(42.39±16.40),(36.76±16.12)μmol·L~(-1),差异有统计学意义(P<0.01);且其分别有27例(20.30%)和13例(7.56%)患儿发生高血氨,差异有统计学意义(P<0.01)。VPA+LEV组与VPA1组患儿的血氨浓度分别为(39.25±18.04),(36.76±16.12)μmol·L~(-1),差异无统计学意义(P>0.05);且其高血氨发生率分别为10.47%和7.56%,差异无统计学意义(P>0.05)。VPA+LTG组、VPA+OXC组与VPA2组患儿的血氨浓度分别为(33.22±15.70),(39.88±20.30),(34.02±17.76)μmol·L~(-1),差异无统计学意义(P>0.05);且其高血氨发生率为5.13%,9.09%,4.08%,差异无统计学意义(P>0.05)。结论 TPM能增加VPA升高血氨的风险,加重药物不良反应。临床上VPA联用TPM时,应注意监测患儿的血氨浓度,避免药物不良反应的发生。
Objective To observe the effect of valproate (VPA) combined with new antiepileptic drugs (AEDs) on serum ammonia in children with epilepsy. Methods The clinical data of children with epilepsy treated with VPA and VPA combined with topiramate (TPM), levetiracetam (LEV), lamotrigine (LTG) and oxcarbazepine (OXC) The subjects were divided into VPA group, VPA + TPM group, VPA + LEV group, VPA + LTG group and VPA + OXC group and age distribution group (divided into VPA1 group and VPA2 group) Concentration and the occurrence of high blood ammonia. Results The serum ammonia concentrations in the VPA + TPM group and the VPA1 group were (42.39 ± 16.40) and (36.76 ± 16.12) μmol·L -1, respectively, with statistical significance (P <0.01) There were 27 cases (20.30%) and 13 cases (7.56%) of children with hyperglycemia, the difference was statistically significant (P <0.01). The serum ammonia concentrations of VPA + LEV group and VPA1 group were (39.25 ± 18.04) and (36.76 ± 16.12) μmol·L -1, respectively, with no significant difference (P> 0.05) The incidence of ammonia was 10.47% and 7.56%, respectively, with no significant difference (P> 0.05). The serum ammonia concentrations in VPA + LTG, VPA + OXC and VPA2 groups were (33.22 ± 15.70), (39.88 ± 20.30) and (34.02 ± 17.76) μmol·L -1, respectively, with no significant difference (P> 0.05). The incidence of hypermonthmia was 5.13%, 9.09% and 4.08%, respectively, with no significant difference (P> 0.05). Conclusion TPM can increase the risk of VPA raising blood ammonia and aggravate adverse drug reactions. Clinical VPA combined with TPM, should pay attention to monitoring the concentration of blood ammonia in children to avoid the occurrence of adverse drug reactions.