卡马西平、丙戊酸钠对甲状旁腺功能及骨密度的影响

The effect of carbamazepine and valproate on function of parathyroid and bone mineral density

目的：探讨两种主要抗癫痫药（ADEs）卡马西平（CBZ）及丙戊酸钠（VPA）对甲状旁腺功能及骨密度（BMD）的影响，旨在为预防药物引起的继发甲状旁腺功能亢进和骨质疏松提供参考。方法：观察了60例年龄在18-40岁间确诊的癫痫患者。30例单独服用丙戊酸钠，30例单独服用卡马西平，时间≥6个月。50例正常成人对照组，每组男女各半。3组均测定其血清甲状旁腺激素（iPTH）、降钙素（CT）、血清钙（Ca^2＋）、血清磷（P^3＋）、碱性磷酸酶（ALP）；分别进行骨密度的测定。结果：卡马西平组血清Ca^2＋、P^3＋的浓度均较正常对照组低，丙戊酸组血清Ca^2＋的浓度较正常对照组高。在这两组中血清PTH、CT、ALP的浓度均较正常对照组高。两组患者的骨密度均出现不同程度的减低。结论：卡马西平和丙戊酸均可引起血VFH、CT的异常增高和骨密度的降低，最终导致继发甲状旁腺功能亢进或骨质疏松。

Aim： To examine the effect of carbamazepine and valproate monotherapy on secondary hyperparathyroidism and bone mineral density in adult. Methods： Thirty adult patients aged 18 -40 years old with epilepsy were treated with VPA alone for over 6 months. Thirty age-matched adults with epilepsy taking CBZ as monotherapy for more than 6 months; and 50 the same age-range and sex-matched volunteers serving as controls. Serum concentrations of calcium （ Ca^2 ＋ ）, phosphate （ p^3 ＋）, intact parathyroid hormone（ iPTH）, Calcitonin（CT） and alkaline phosphatase （ALP） and bone mineral density were examined in all patients and control. Results： Serum concentrations of Ca^2＋, P^3＋ were significant lower in CBZ group than control group, serum concentrations of Ca^2＋ in patients on VPA were significant higher than in CBZ group and control groups. And seru concentrations of ALP, iPTH and CT were pronounced higher in both CBZ group and VPA group than control. Conclusion：Secondary hyperparathyroidism and decrease of bone mineral density can be caused by CBZ and VPA .