左乙拉西坦與拉莫三嗪治療新診斷小兒癲癇療效及對認(rèn)知功能影響的對比研究

袁圣勇 袁莉 潘北香

【摘要】 目的 比較分析兩種新型抗癲癇藥左乙拉西坦與拉莫三嗪治療新診斷兒童癲癇療效及對認(rèn)知功能的影響， 為臨床兒童抗癲癇治療提供一定的理論指導(dǎo)。方法 80例新診斷癲癇患兒， 隨機(jī)分為左乙拉西坦組和拉莫三嗪組， 各40例。左乙拉西坦組給予左乙拉西坦治療， 拉莫三嗪組給予拉莫三嗪治療。比較兩組臨床療效、不良反應(yīng)發(fā)生情況及精神狀態(tài)檢測量表（MMSE）評分。結(jié)果 左乙拉西坦組的總有效率為97.5%， 拉莫三嗪組的總有效率為92.5%， 兩組比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。兩組藥物治療期間， 左乙拉西坦組的不良反應(yīng)發(fā)生率為7.5%， 明顯低于拉莫三嗪組的25.0%， 差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療前及治療后3、6個(gè)月， 兩組的MMSE評分比較差異均無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 兩種新型抗癲癇藥左乙拉西坦和拉莫三嗪治療新診斷兒童癲癇的臨床療效及對認(rèn)知功能的影響沒有明顯的差異， 但左乙拉西坦的不良反應(yīng)明顯少于拉莫三嗪， 因此左乙拉西坦的總體效果要優(yōu)于拉莫三嗪。

【關(guān)鍵詞】 左乙拉西坦;拉莫三嗪;兒童癲癇;認(rèn)知功能

DOI：10.14163/j.cnki.11-5547/r.2019.19.048

【Abstract】 Objective? ?To compare and analyze the efficacy of two new antiepileptic drugs of levetiracetam and lamotrigine in the treatment of newly diagnosed pediatric epilepsy and their effects on cognitive function， so as to provide some theoretical guidance for clinical antiepilepsy. Methods? ?A total of 80 newly diagnosed epilepsy children were randomly divided into levetiracetam group and lamotrigine group， with 40 cases in each group. Group A was treated with levetiracetam， and group B was treated with lamotrigine. Comparison were made on clinical efficacy， occurrence of adverse reactions and mini-mental state examination （MMSE） scores in two groups. Results? ?Levetiracetam group had total effective rate as 97.5%， and lamotrigine group had total effective rate as 92.5%， and the difference was not statistically significant （P>0.05）. During drug therapy， levetiracetam group had lower incidence of adverse reactions as 7.5% than 25.0% in lamotrigine group， and the difference was statistically significant （P<0.05）. Before treatment and after 3 and 6 months of treatment， both groups had no statistically significant difference in MMSE score （P>0.05）. Conclusion? ?There is no significant difference in the clinical efficacy and cognitive function between two new antiepileptic drugs of levetiracetam and lamotrigine in the treatment of newly diagnosed pediatric epilepsy， but the adverse reaction of levetiracetam is significantly less than that of lamotrigine， so the overall effect of levetiracetam is better than that of lamotrigine.

【Key words】 Levetiracetam; Lamotrigine; Pediatric epilepsy; Cognitive function

癲癇（epilepsy）是一種由大腦神經(jīng)元細(xì)胞反復(fù)異常放電引起以腦功能異常為特點(diǎn)的慢性疾病， 其中一半以上的癲癇患者在兒童時(shí)期發(fā)病。癲癇目前主要以藥物治療為主， 兒童癲癇治療與成人的癲癇治療有明顯的不同， 在兒童癲癇的治療過程中， 選擇療效明顯、不良反應(yīng)輕微并且依從性好的抗癲癇藥物進(jìn)行治療顯得更為重要。但是關(guān)于兒童抗癲癇治療方案國內(nèi)外尚無統(tǒng)一標(biāo)準(zhǔn)， 現(xiàn)有的兒童抗癲癇藥物的使用方法大多來自于成人抗癲癇治療研究的簡單延伸。左乙拉西坦、拉莫三嗪均為臨床常用的新型抗癲癇藥物， 前者作用機(jī)制主要通過與突觸囊泡蛋白SV2A結(jié)合調(diào)節(jié)神經(jīng)遞質(zhì)的釋放而發(fā)揮抗癲癇作用[1]， 具有廣譜抗癲癇活性， 起效速度快、安全性高、患兒耐受性佳[2]， 后者可通過阻滯鈉通道， 穩(wěn)定細(xì)胞膜， 阻止興奮神經(jīng)介質(zhì)釋放， 對部分性發(fā)作癲癇療效較好[3]。本文主要研究左乙拉西坦與拉莫三嗪治療新診斷兒童癲癇療效及對認(rèn)知功能的影響， 為臨床兒童抗癲癇治療提供一定的理論指導(dǎo)。現(xiàn)報(bào)告如下。