托吡酯对癫患儿糖代谢的影响

Effect of topiramate on glycometabolism in children with epilepsy.

目的 了解托吡酯治疗后癫患儿血糖、胰岛素、食欲、甘丙肽、瘦素变化,探讨托吡酯对糖代谢的影响。方法 采用放射免疫法测定2 0 0 3年2～10月在河北省儿童医院就诊的4 1例癫患儿服用托吡酯(3 93±1 6 0 )mg/ (kg·d) 4个月前后血浆甘丙肽和血清瘦素和空腹血糖、胰岛素的浓度,并了解食欲变化。结果 服药后的血糖由4 .87mmol/L降至4 . 6 9mmol/L ;胰岛素由6 . 78mIU/L升至7. 4 2mIU/L ;甘丙肽服药后由2 6 14ng/L降到2 0 . 4 6ng/L ;而瘦素则从(1 .32±0 .5 7) μg/L升为(1. 91±1. 10 ) μg/L。服药前有4例食欲不好,服药后有19例出现食欲减退。结论 服用托吡酯会引起体内血糖降低、胰岛素升高、食欲下降,这些变化可能为托吡酯导致的甘丙肽降低和瘦素升高所致。

Objective The purpose of this study was to determine the effect of topiramate on glycometabolism in children with epilepsy by observing the change of blood glucose,insulin,food appetite,galanin and leptin after taking topiramate.Methods Forty-one patients continued receiving topiramate (3.93±1.60)mg/(kg·d) for 4 months.Body weight,body height,appetite and fasting glucose were evaluated before and after treatment.At same time,plasm insulin,plasm galanin,serum leptin circulating levels were detected with radioimmunoassay.Results After treatment,fasting glucose levels fell (4.87mmol/L vs 4.69mmol/L, P <0.05) and plasm insulin rose (6.78mIU/mL vs 7.42mIU/mL ).Plasma galanin level was loweded significantly compared with baseline (26.14ng/L vs 20.46ng/L,P<0.01),whereas serum leptin was increased[(1.32 ±0.57)μg/L vs (1.91±1.10)μg/L, P <0.01].Before treatment there were 3 cases while after treatment 19 cases with bad food appetite( P <0.001).Conclusion Topiramate treatment can lower the fasting glucose and raise the plasm insulin in children with epilepsy,which may be caused by the decrease of plasm galanin level and increase of leptin.