托吡酯对癫癎患者骨代谢的影响

Topiramate on bone metabolism in patients with epilepsy

目的探讨长期服用托吡酯对成人癫癎患者骨代谢的影响及其可能机制。方法将长期服用抗癫癎药治疗的成人癫癎患者,分为单独服用非肝酶诱导剂托吡酯组、单独服用肝酶诱导剂(卡马西平、苯巴比妥等抗癫癎药物)组,服药疗程均>6个月。并设健康成人为对照组;对各组进行骨密度测定,检测骨形成的特异性指标(骨碱性磷酸酶),骨吸收的特异性指标(尿中脱氧吡啶啉),同时检测血钙、血磷含量及24小时尿钙尿磷的排泄量及血中甲状旁腺激素含量。结果肝酶诱导剂组及托吡脂组均表现不同程度的骨代谢异常,生化指标改变早于骨密度改变。托吡酯主要通过增加尿钙尿磷的排泄量,促进机体钙的丢失,其次还通过减少骨质形成,综合影响了骨质代谢。结论托吡酯与肝酶诱导剂类抗癫癎药物相比,导致骨量减少较轻,但同样影响骨代谢。早期加强钙的摄入,可以预防骨质疏松的发生。

Objective To investigate bone metabolism in adult patients with epilepsy who take topiramate and its possible mechanism. Methods We seperate Congterm artiepilepic drug taken adult people who suffer from epilepic into two groups, induction of non-liver-enzyme topiramate group （22 cases）, induction of liver enzymes （carbamazepine, phenobarbital, and other antiepileptic drug） group （41 cases）, medication regimens are more than six months. And set healthy adults （n = 15） for the control group,detecting bone mineral density, specific indicators of bone formation （bone alkaline phosphatase （ALP）） and bone resorption （urinary deoxypyridinoline-（Deoxypyridinoline, DPD））, calcium, phosphorus content, 24-hour urinary excretion of calcium and phosphorus and parathyroid hormone level in the blood. Results The results of liver enzymes induced lipid group and topiramate group showed varying degrees of abnormal bone metabolism, the changes of biochemical indicators were earlier than that of bone mineral density. Topiramate major increased urinary excretion of calcium and phosphorus to promote the loss of body calcium, also by reducing bone formation, combined affected bone metabolism. Conclusion Long-term use of antiepileptic drug topiramate can lead to abnormal bone metabolism, may eventually lead to bone loss, and strengthening of early calcium intake, calcium excretion can be reduced to achieve early prevention of the osteoporosis.