托吡酯对儿童骨代谢的影响及其相关机制的研究

The effect of topiramate on bone metabolism in children and its realtive mechanism

目的：探讨抗癫痫药（AED）托吡酯（TPM）对儿童骨代谢的影响及其发生机制，企为临床制定防治措施提供一个理论基础。方法：收集43例无肝、肾损害及其他特殊疾病，近期未应用糖皮质激素和治疗剂量维生素D的癫痫患儿的血清和尿液，并以其中服药前的癫痫患儿13例（作为对照组）和TPM组30例，测定其血清碱性磷酸酶（ALP）和尿脱氧吡啶啉／尿肌酐（DPD／Cr），同时，对服用TPM的患儿体内血Ca2＋、HCO-水平进行常规实验室检查。采用SPSS10．0统计软件进行统计学分析。结果：TPM组血清AI。PF（20．13±4．44）U／L]与对照组[（14．75±2．39）U／L]之间差异有非常显著意义（P〈o．01），TPM组尿DPD／Cr与对照组之间差异有显著意义（P〈0．05），两组中的血清ALP和尿DPD／Cr之间的相关性（相关系数r分别为-0．083、-0．396）均无统计学意义（P〉0．05）。TMP组患儿血Ca2＋、HCO-的结果分别为：（1．10±0．08）mmol／L，（16．28±1．09）mmol／L，均低于正常值范围2．12～2．75mmol／L和22～28mmol／L。服用TPM的癫痫患儿血Ca2＋水平与其ALP和DPD／Cr水平无显著相关性（r=-0．183，-0．288P〉0．05），该组患儿血HCO。水平与其ALP和DPD／Cr水平无显著相关性（r=0．321，0．285P〉0．05），血Ca2＋与HCO一之间无显著相关性（相关系数r=0．064，P〉0．05）。结论：TPM对儿童骨代谢的影响包括骨形成和骨吸收两个方面，服用TPM的癫痫患儿不仅需要补充钙剂和维生素D，还应定期检测血浆HCO3-水平。

Objective：To investigate the association between topiratmate（TPM）,a kind of antiepi- leptic drugs（AEDs） and bone metabolism in children,discuss the relavant mechanism and provide a theo- retical base on drawing prophy lactic and therapeutic messures. Methods：The entrance standard for this study was epileptic children who didn＇t receive glucocorticosteroid, therapeutic dose of vitamin D, and with no liver and kidney diseases,and special abnormabilities. 43 children with epilepsy were selected in this study 13 children without treatment as the control group. 30 chlidren were treated with TPM. The markers of serum alkaline phosphatase（ALP） and urine deoxypyridinoline/urine creatinine（DPD/Cr） was measured. At the same time, plasma calcium（Ca2＋） and bicarbonate（HCO3- ） level of children treated with TPM in laboratory were routinely mensurated. The data were analyzed with SPSS 10.0 statistic soft- ware. Results.. There were significant difference of ALP level between TPM treated group and the control group（P〈0. 01）. There were significant difference of DPD/Cr level between bothgrouos（P〈 0. 05）. There were no significant correlation between ALP level and DPD/Cr level in each group （r=-0. 083, -0. 396 P 〉0. 05）. The level of plasma Ca2＋ and HCO3 in TPM treated group was （1. 10 ± 0.08）mmol/L, （16.28± 1.09）mmol/L, respectively, and both were lower than the range of the normal level（2.12 ± 2.75 mmol/L vs. 22 - 28 mmol/L）. There was no significant correlation between plasma Ca2＋ and ALP or DPD/Cr in TPM treated group（r= -0. 183,-0. 288 P〈0.05） ,There was no signifi- cant correlation between plasma HCO3 and ALP or DPD/Cr in TPM treated group （r=0. 321,0. 285 P 〉0.05）. There was no significant correlation between plasma Ca2＋ and h plasma HCO3- （r= -0. 064, P 〉0.05）. Conelusion：TPM may influence bone metabolism including bone formation and absorption. The patient treated with TPM needs not only supplementation of calcium and vitamin D, but periodic measure- ment of plasma HCO3-.