托吡酯与卡马西平对成年癫痫患者甲状腺激素的影响

Effects of topiramate and carbamazepine on serum thyroid hormone levels in adults with epilepsy

目的探讨托吡酯(TPM)及卡马西平(CBZ)对成年癫痫患者甲状腺激素水平的影响。方法选择新确诊的100例成年癫痫患者(50例服用TPM、50例服用CBZ)为试验组,用化学发光法测定用药前甲状腺激素水平并与40例成年健康对照进行比较;再经TPM、CBZ单药治疗3、6个月及1年后检测血中甲状腺激素水平,并与治疗前比较。结果未经治疗的癫痫患者甲状腺激素水平与正常对照组比较无显著性差异(P>0.05);与治疗前相比,CBZ治疗3个月、6个月及1年后的游离T4(FT4)、三碘甲状腺原氨酸(TT3)及CBZ治疗6个月及1年后的甲状腺素(TT4)显著降低(P<0.05),而CBZ治疗3个月的TT4与服用CBZ后各时点的游离T3(FT3)、促甲状腺素(TSH)无显著性变化(P>0.05);经TPM治疗后的不同时段的甲状腺激素水平与治疗前比较均无显著性差异(P>0.05)。结论CBZ治疗可造成成年癫痫患者甲状腺激素水平的降低。癫痫本身及TPM治疗并不引起成年患者甲状腺激素水平的改变,表明TPM治疗对成年癫痫患者的甲状腺功能更安全。

Objective To evaluate the effects of topiramate（TPM）and carbamazepine（CBZ） on serum thyroid hormone concentrations in adults with epilepsy. Methods Serum thyroid hormone levels were measured by using chemoluminescence in 100 newly diagnosed epileptic adults（50 taking TPM ,50 taking CBZ monotherapy） before treatment with antiepileptic drugs and compared them with 40 healthy controls. The changes of thyroid hormone levels were observed after 3,6 and 12 months treated with TPM and CBZ respectively,and then compared. Results No significant difference in thyroid hormone levels was observed between the untreated patients and the healthy controls （P〉0.05）. FT4 and TT3 concentrations were significantly lower in 50 patients in 3,6 and 12 months of treatment with CBZ monotherapy（P〈0.05）. TT4 level was also significantly lower in 50 patients in 6 and 12 months of treatment with CBZ monotherapy （P〈0.05）. There was no significant difference in thyroid hormone levels in patients before and in 3,6 and 12 months of treatment with TPM monotherapy（P〉0.05）. Conclusion Serum thyroid hormone concentrations are low in CBZ-treated adults with epilepsy. Epilepsy and TPM monotherapy have no effect on serum thyroid hormone levels in adults with epilepsy,indicating that TMP is safer to thyroid function of adults with epilepsy.