丙戊酸治疗成人癫致血浆肉毒碱下降

Decrease of plasma free carnitine in epileptic patients treated with valproic acid

目的观察丙戊酸(valproic acid,VPA)治疗成人癫患者后患者血浆游离肉毒碱改变规律,并探讨导致其改变的相关因素。方法VPA治疗组为41例成人癫患者,其中接受VPA单药治疗者33例,联合其他抗癫药物治疗者8例,30例非VPA治疗的成人癫患者作为癫对照组,包括其他抗癫药物治疗的患者14例,和未进行药物治疗的患者16例。33名同龄健康者作为正常对照,用酶循环法测定血浆游离肉毒碱浓度,3组间进行比较。结果VPA治疗组血浆游离肉毒碱浓度(31.43±11.75μmol/L)明显低于正常对照组(43.25±12.57μmol/L)和非VPA治疗的癫对照组(40.71±12.83μmol/L,P均<0.05)。血浆游离肉毒碱浓度与VPA剂量、VPA疗程、其他抗癫药物、年龄、性别、血ALT、AST无相关性。结论VPA治疗成人癫可能导致血浆游离肉毒碱水平下降,其下降程度和VPA无剂量和疗程依赖性,也不受患者的生理状态以及其他抗癫药物的影响。

Objective To evaluate the effect of valproic acid （VPA） on serum free carnitine in adult epileptic pa- tients, and to explore its associated risk factors. Material and Methods Forty-one adult epileptic patients, treated with VPA only or with other antiepileptic drugs （AEDs） together, were collected within outpatients. Fourteen adult epileptic pa- tients, only treated with other antiepileptic drugs and sixteen patients without AEDs therapy were enrolled as non-VPA epi- lepsy controls of and thirty-three healthy persons as normal controls. Serum free carnitine levels were determined by an enzy- matic reaction method and analysed the difference statistically among the three groups. Results The mean free carnitine level was significantly lower in VPA group （31.43 ± 11.75 μmol/L） compared with normal controls （43.25 ± 12. 57 μmol/ L） and epilepsy controls （40. 71 ± 12. 83 μmol/L, P 〈 0.05 ）. There were no significant differences in concentrations caruitine between epilepsy controls and normal controls. There were no significant associations between serum concentrations of free carnitine and dosage and treatment duration of VPA, other antiepileptic drugs, sex, age, serum ALT and AST activi- ties. Conclusions VPA could have a significant decrease in serum free carnitine concentrations In adult epileptic patients, the physiological status of patients and other antiepileptic drugs could have no effect on the level of serum free carnitine.