多烯磷脂酰胆碱对癫痫患者认知功能影响的临床疗效

Therapeutic effect of polyene phosphatidyl choline combined with valproic acid on cognitive function in epileptic patients

目的明确临床上多烯磷脂酰胆碱（PPC）联合丙戊酸镁（VPA-Mg）改善癫痫后认知功能障碍的作用。方法将第四军医大学西京医院门诊收集的符合要求的42例癫痫患者随机分为VPA-Mg联合PPC治疗组（VPA-Mg＋PPC组，n=20）和单独使用VPA-Mg组（VPA—Mg组，n=22）。观察24周后，对两组资料进行分析。结果两组患者在病程、发作类型、月平均发作次数以及受教育程度等差异无统计学意义（P〉0．05），具有可比性。VPA-Mg＋PPC组在访视1与访视4时的平均月发作频率之间差异具有统计学意义[（1．2±1．1）w（0．4±0．6），P〈0．05]；VPA—Mg组在访视1与访视4时的平均月发作频率差异亦有统计学意义[（1．5±1．4）VS（0．6±0．6），P〈0．05]，但两组间的疗效比较差异无统计学意义（P〉0．05）。VPA-Mg＋PPC组认知评定较VPA-Mg组改变明显，差异具有统计学意义（P〈0．05）。没有严重不良反应发生，但有轻度不良反应及实验室数据异常存在。VPA-Mg组胸闷1例，脱发1例，腹痛1例，谷丙转氨酶偏高2例。VPA—Mg＋PPC组在在整个试验过程中没有出现不良反应，且改善了伴有肝功能异常的病例。结论VPA-Mg与PPC联合治疗癫痫患者不仅可以控制癫痫发作，抵抗丙戊酸镁对肝脏方面的不良反应，而且可以明显改善癫痫患者的认知功能损害。

Objective To determine the therapeutic effect of polyene phosphatidyleholine （PPC） combined with valproic acid magnesium（VPA-Mg） on cognitive function in patients with epilepsy. Methods A total of 42 outpatients with identified epilepsy in Xijing Hospital during December 2011 to September 2012 were randomly divided into 2 matched groups, that is, VPA-Mg＋PPC group （n=20） and VPA-Mg group （n=22）. Their clinical data before, and in 4, 12 and 24 weeks after treatment were observed and analyzed. The Beijing version of Montreal cognitive assessment and the Alzheimer＇s disease assessment scale-cognitive were used to evaluate their cognitive function. Results There was no significant difference in the course of disease, seizure types, monthly average seizure frequency and levels of education attainment between the two groups. Monthly average seizure frequency was significantly decreased in VPA-Mg＋PPC group 24 weeks after treatment （1.2 ± 1.1 vs 0.4 ±0.6, P〈 0.05）. The same was in VPA-Mg group （1.5 ± 1.4 vs 0.6 ±0.6, P〈 0.05）. But no significant difference was found between the two groups （P〉 0.05）. Cognitive evaluation was more obviously improved in VPA-Mg＋PPC group than in VPA-Mg group （P 〈 0.05）. No severe complication was found during treatment, but there were mild adverse reactions and abnormal laboratory results in VPA-Mg group. There were 1 case of chest tightness, 1 case of alopecia, 1 case of abdominal pain, and 2 cases of mildly increased glutamic-pyruvic transaminase. There was no such adverse reaction in VPA-Mg＋PPC group, and liver functions were restored to normal in some cases. Conclusion Combined therapy of VPA-Mg and PPC not only controls the seizures in patient with epilepsy, resists adverse reactions in the liver caused by VPA-Mg, but also improves their cognitive impairment.