不同抗癫痫药对癫痫患儿体液免疫的影响

Influence of different anti-epileptic drugs on humoral immunity in epileptic children

目的:观察癫痫患儿长期服用不同抗癫痫药后的体液免疫反应。方法:采用免疫比浊法测定本院小儿神经专科112例癫痫患儿服药1年后血清IgA、IgG、IgM及补体C3、C4水平,并与30例正常健康儿童比较,VAP(丙戊酸盐)单药、VAP联合TPM(托吡酯)或LTG(拉莫三嗪)间体液免疫水平的差异。结果:①112例癫痫患儿血清IgM浓度平均为(1.62±0.72)g/L,IgG浓度平均为(11.20±2.79)g/L,与对照组比,均升高(P<0.05,P<0.01),补体C3浓度平均为(948±163)mg/L,C4浓度平均为(180±80)mg/L,均下降(均P<0.01),血清IgA浓度平均为(1.26±0.67)g/L(P>0.05)。②VAP单药治疗后,血清IgA明显下降(P<0.01),VAP联合TPM或LTG治疗后,血清IgA升高(P<0.01)。结论:癫痫患儿长期服用不同抗癫痫药后,存在体液免疫紊乱,且表现复杂,IgM、IgG升高,C3、C4下降,单用丙戊酸盐后,IgA显著下降。

Objective：To observe the condition of humoral immunity in epileptic children after a long-term treatment with different antiepileptic drugs. Methods ： 112 epileptic children and 30 normal healthy subjects were enrolled in the study. By nephelometry method, the concentrations of serum IgA, IgM, IgG and C3, C4 complement proteins were measured after one year treatment and a comparative study was made of the qualitative differences between VAP （Valproate） monotherapy and VAP polytherapyu with TPM （topiramate） or LTG （Lamotrigine）. Results： 1. When compared to control group, 12 epileptic children had a significant elevation in IgM （ 1.62 ± 0.72） g/L and IgG （ 11.20 ± 2.79 ） g/L （ P 〈 0.05, P 〈 0.01 respectively）, and a reduction in C3 （ 948 ± 163 ） mg/L and CA （ 180 ± 80 ） mg/L （ both P 〈 0.01 ） , no significant difference in serum IgA （ 1.26 ± 0. 67）g/L（P 〉 0. 05）. 2. Serum IgA level in VAP monotherapy had a significantly dicrease （P 〈 0. 01 ）, conversely,increase in VAP polytherapyn with TPM or LTG（ P 〈 0.01 ）o Conclusions ：There were abnormalities of humoral immunity in epileptic children after a long-term treatment with different antiepileptic drugs and had a complex manifestation, the serum IgM and IgG elevated, C3 and C4 reduced, serum IgA in VAP monotherapy than VAP combined with TPM or LTG decreased significantly.