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目的探讨癫痫患儿服用丙戊酸(VPA)后高氨血症的发生情况及意义。方法 2006年1月至2010年6月青岛大学医学院附属医院儿科门诊、神经科门诊和病房单用VPA且资料完整的癫痫患儿78例,测量其用药后血氨的变化,分析伴或不伴症状的高氨血症与VPA药物剂量、药物浓度、癫痫病因的相关性。结果单用VPA的癫痫患儿发生VPA相关性高氨血症21例,其中有症状者13例。特发性和隐源性癫痫(ICE)组中的血氨值明显高于症状性癫痫(SE)组(P<0.05),但服用VPA剂量及血VPA药物质量浓度均低于SE组(P<0.05)。无症状-ICE组服用VPA剂量低于无症状-SE组(P<0.05)但血氨浓度和血VPA质量浓度与无症状-SE组差异无统计学意义(P>0.05);而有症状-ICE组血氨浓度高于有症状-SE组(P<0.05),但服用VPA剂量及血VPA质量浓度低于有症状-SE组(P<0.05)。ICE组内与SE组内无论是否有症状,其血氨、服用VPA剂量和血VPA药物质量浓度差异皆无统计学意义(P>0.05)。结论临床医生应密切关注服用VPA的癫痫患儿,一旦发生高氨血症应予停药。
Objective To investigate the occurrence and significance of hyperammonemia in children with epilepsy after taking valproate (VPA). Methods From January 2006 to June 2010, 78 cases of children with epilepsy with VPA and complete ward data of pediatric outpatient, neurology outpatient and wards in Affiliated Hospital of Medical College of Qingdao University were enrolled. Their blood ammonia levels were measured after treatment. Associated symptoms of hyperammonemia and VPA drug dose, drug concentration, the etiology of epilepsy. Results There were 21 cases of VPA-related hyperammonemia in VPA-only epilepsy children, of which 13 cases were symptomatic. Blood ammonia values in idiopathic and cryptogenic epilepsy (ICE) groups were significantly higher than those in symptomatic epilepsy (SE) groups (P <0.05), but VPA dose and blood VPA drug concentrations were lower than those in SE group (P <0.05). The asymptomatic -ICE group had no significant difference in dose of VPA when compared with asymptomatic-SE group (P <0.05), but there was no significant difference in serum ammonia concentration, blood VPA concentration and asymptomatic-SE group (P> 0.05) The serum ammonia concentration in ICE group was higher than that in symptomatic-SE group (P <0.05), but VPA dose and blood VPA concentration were lower than those in symptomatic-SE group (P <0.05). There was no significant difference in blood ammonia, VPA dose and blood VPA drug concentration between ICE group and SE group with or without symptoms (P> 0.05). Conclusions Clinicians should pay close attention to children with epilepsy who take VPA. Patients with hyperammonemia should be discontinued.