目的:癫痫是神经系统常见病,半数以上患者儿童时期便发病,癫痫病患者常需终身服用抗癫痫药。研究表明,长期服用抗癫痫药物会影响骨代谢,加速骨矿物质的丢失,导致骨质疏松。但是,每种抗癫痫药物的具体作用还不清楚。作为典型的肝酶诱导剂的抗癫痫药物,卡马西平已经公认有降低骨密度的作用,但是作为非肝酶诱导剂的丙戊酸钠,还没有定论。在新型抗癫痫药物中,奥卡西平、托吡酯和拉莫三嗪等对骨密度似乎没有影响,但目前相关的研究很少,各研究所得结果也不一致。本研究拟通过荟萃分析评估抗癫痫药对癫痫病儿童骨密度和骨代谢的影响。创新点:目前已有荟萃分析评估抗癫痫药对成人骨密度的影响,但尚无研究分析抗癫痫药对儿童的影响。方法:检索PubMed和Web of Science数据库中评估抗癫痫药与儿童骨密度及骨代谢关系的临床试验。入选标准为:(1)至少包括一项骨代谢的标志物;(2)骨密度用双能×线吸收计量法计算;(3)研究结果包括平均的骨密度和骨密度的标准差;(4)年龄小于18岁;(5)患者采用单药或多药治疗;(6)具有健康对照组;(7)必须是观察性研究或随机对照研究。采用固定效应模型和随机效应模型对22篇文献的1492例患者中的骨密度及骨代谢资料进行荟萃分析,结果用加权均数差(WMD)或标准均数差(SMD)进行评估。结论:共22篇文献符合纳入标准,共计1492例患者。荟萃分析的结果显示,抗癫痫药物的使用可以引起儿童:(1)腰椎、转子、股骨颈的骨密度和全身骨密度的下降;(2)维生素D下降和血清碱性磷酸酶的上升;(3)甲状旁腺激素、钙和磷没有显著改变。荟萃分析的结果表明,抗癫痫药的使用可能和癫痫病患儿骨密度降低相关。 Objectives: Epilepsy is a common disease of the nervous system, more than half of patients with childhood disease onset, epilepsy often require lifelong use of antiepileptic drugs. Studies have shown that long-term use of anti-epileptic drugs can affect bone metabolism, accelerate bone mineral loss, leading to osteoporosis. However, the exact role of each antiepileptic drug is unclear. As an antiepileptic drug that is a typical liver enzyme inducer, carbamazepine has been recognized as having a role in reducing bone density, but sodium valproate, which is not a hepatic enzyme inducer, has not yet been elucidated. Of the new antiepileptic drugs, oxcarbazepine, topiramate, and lamotrigine seem to have no effect on bone mineral density, but few studies are currently available and the results obtained from each study are also inconsistent. This study was intended to evaluate the impact of antiepileptic drugs on bone mineral density and bone metabolism in children with epilepsy by meta-analysis. Innovative point: There are meta-analysis to evaluate the impact of antiepileptic drugs on adult bone mineral density, but no studies have analyzed the impact of antiepileptic drugs on children. METHODS: Clinical trials evaluating the relationship between anti-epileptic drugs and bone mineral density and bone metabolism in PubMed and Web of Science databases were searched. The inclusion criteria were: (1) at least one marker of bone metabolism was included; (2) bone mineral density was calculated using dual energy x-ray absorptiometry; (3) the results included the mean standard deviation of BMD and BMD; 4) patients younger than 18 years of age; (5) patients treated with single or multi-drug; (6) with a healthy control group; (7) must be observational or randomized controlled study. A meta-analysis of bone mineral density and bone metabolism data from 1492 patients from 22 articles using the fixed-effects model and the random-effects model was performed using either the weighted mean difference (WMD) or the standard mean difference (SMD). Conclusion: A total of 22 articles met the inclusion criteria for a total of 1492 patients. The results of the meta-analysis showed that the use of anti-epileptic drugs can cause children: (1) the lumbar spine, the rotor, femoral neck bone mineral density and systemic bone mineral density decreased; (2) vitamin D decreased and elevated serum alkaline phosphatase; ( 3) Parathyroid hormone, calcium and phosphorus did not change significantly. The results of the meta-analysis show that the use of anti-epileptic drugs may be associated with decreased bone mineral density in children with epilepsy.