卡马西平对癫痫患儿甲状腺激素水平影响的临床观察

Effect of carbamazepine on serum levels of thyroid hormones in epileptic children

目的 探讨卡马西平 (CBZ)对癫痫患儿甲状腺激素水平的影响。方法 对 2 7例初诊为癫痫患儿行CBZ单药治疗前、平均治疗 3个月后及 2 5例长期行CBZ单药治疗平均 1年 7个月后的癫痫患儿 ,用放射免疫法分别测定血清甲状腺素 (T4 )、游离T4 (FT4 )、三碘甲腺原氨酸 (T3)、游离T3(FT3)及促甲状腺激素 (TSH)的水平 ,并以 32例健康儿童作为对照。结果 CBZ平均治疗 3月后T4 、FT4 分别为 (113 1± 40 6 )nmol/L和 (16 6± 3 6 )pmol/L ,均明显低于治疗前的 (138 2± 35 6 )nmol/L(P <0 0 1)和 (2 0 5± 4 5 ) pmol/L(P <0 0 1)。长期服用CBZ平均 1年 7个月的患儿与健康对照组相比 ,T4 、FT4 水平同样降低 ,分别为 (10 8 9± 44 6 )nmol/L(P <0 0 5 )和 (15 5± 3 7) pmol/L(P <0 0 0 1)。结论 甲状腺激素水平的改变与CBZ的肝酶诱导作用有关 。

Objective To evaluate the effect of carbamazepine(CBZ) monotherapy on serum levels of thyroid hormones in epileptic children.Methods 27 children with recently diagnosed epilepsy before treatment with CBZ and after 3 months treatment with CBZ were measured the serum concentrations of thyroxine(T 4),free thyroxine(FT 4),thyriiodothyronine(T 3),free thyriiodothyronine(FT 3) and thyrotropin(TSH) via radioimmunoassay.25 children receiving one year and seven months of treatment with CBZ and 32 healthy control subjects were also studied.Results Levels of serum T 4,FT 4 were decreased after 3 months of therapy with CBZ in comparison with those of before CBZ treatment [(113 1±40 6)nmol/L vs (138 2±35 6)nmol/L, P< 0 01 and (16 6±3 6)pmol/L vs (20 5±4 5)pmol/L,P<0 01,respectively].The children receiving long-term treatment with CBZ (average one year and seven months) had the same low levels of the T 4 and FT 4 compared with normol controls.They were (108 9± 44 6)nmol/L (P<0 05) and (15 5±3 7)pmol/L(P<0 001),respectively.Conclusion The change in levels of thyroid hormones may be a result of an increased catabolism of these hormones in the liver caused by the enzyme-inducing properties of CBZ.It is important that thyroid function in epileptic children during CBZ therapy should be evaluated.