妥泰与癫痫儿童轻度代谢性酸中毒

The effect of topiramate on acid-base balance, electrolytes metabolism and the function of kidney in epilepsia children

目的:观察妥泰治疗儿童癫痫时其体内酸碱平衡的变化。方法:56例分成三组:(1)A组10例(未服药);(2)B组32例(单独服用妥泰);(3)C组14例(妥泰与其他抗癫痫药CBZ、VPA、NZP等联合应用)。观察指标:血气电解质分析(pH,Pco2HCO3-,BE,K+,Ca2+,Cl-,AG)。结果:与A组比较,B组和C组的癫痫患儿血浆HCO3-(mmol/L)分别降低22%(P<0.01)和16%(P<0.01)。BE值(mmol/L)分别降低225%(P<0.01)和154%(P<0.01)。但B组和C组之间上述指标比较,无显著性差异。各组的pH、Pco2和AG相比较,均无显著性差异。B、C两组血CI(mmol/L)均高于A组,差异有显著意义(P<0.01)。结论:妥泰可导致癫痫患儿代偿性AG正常型高氯性代谢性酸中毒(98%为轻度酸中毒)。

Objective: : To investigate the effect of topiramate (TPM) on acid-base balance, electrolytes metabolism in epilepsia children. Method: All 56 epilepsia children who had normal function of liver and kidney were divided into three groups: A group: 10 children (control); B group: 32 children (TPM); C group: 14 children (Combination of TPM and CBZ, VPA or NZP). Assessment parameters included analysis of blood and gas (pH, Pco2 , HCO3- , BE, K+ , Ca2+ , CI ,AG). Results: Blood and gas analysis. Serum HCO3-(mmol/L) was 21. 6±3. 1 in group A, 16. 8 ±1. 7 in group B and 18. 1±1. 3 in group C, respectively. The average decrease of riCO3- is 22% in group B ( P<0. 01 ) 和 16% in group C (P<0. 01), respectively, compared with group A. The BE ( mmol/L ) was - 7. 8±1. 7 in group B, and -6. 1±1. 3 in group C. The average decrease of BE was 225%(P<0. 01) in group B and 154%(P<0. 01) in group C than group A ( - 2. 4±2. 7), respectively. There was no difference on BE between group B and C and no difference on pH, Pco2 and AG among the three groups. 2. Electrolytes. Blood Cl(mmol/L)in group B and C kept same value(110±2), 5. 5% increase (P<0. 01) than group A ( 104±1 ) . Even thought there was a tendency of decreasing on blood K+ and Ca2+ in group B and C, no statistic significant existed among the three groups. Conclusion: TPM can induce normal anion gap metabolic acidosis and electrolytes disorder in epilepsia children.