女性癫痫患者血清性激素水平的调查研究

Investigation of serum sex hormone levels in women with epilepsy

目的了解癫痫发作频率、抗癫痫单药/联合用药治疗及围经期癫痫对女性癫痫患者性激素水平的影响。方法测定入组的87例女性癫痫患者血清泌乳素、雌激素、孕激素、睾酮水平,根据发作频率、单药/联合用药治疗及是否围经期癫痫分组,并比较不同组间性激素的变化。结果高发作频率组泌乳素升高率及发病年龄明显高于低发作频率组和无癫痫发作组;其孕激素下降率高于低发作频率组(P均<0.05)。联合用药治疗组睾酮升高率明显高于单药治疗组(P<0.05)。围经期癫痫组泌乳素升高率、孕激素下降率及雌/孕比值明显高于非围经期癫痫组(P均<0.05)。结论泌乳素升高与近期癫痫发作有关;孕激素下降与癫痫发作严重性有关;抗癫痫药物影响性激素水平,尤以联合应用丙戊酸钠对睾酮作用显著。孕激素、雌/孕比与围经期癫痫密切相关,孕激素补充疗法可能是治疗围经期癫痫的一条有效途径。

Objective To investigate the effects of seizure frequency, antiepileptic monotherapy/combination therapy, and perimen- strual epilepsy on serum sex hormone levels in women with epilepsy. Methods Eighty-seven women with epilepsy were included in the study and grouped according to seizure frequency, monotherapy or combination therapy, and presence or absence of perimenstrual epi- lepsy. Serum levels of prolactin （PRL）, estradiol （E2 ）, progesterone （P）, and testosterone （T） were determined and compared be- tween the groups. Results The rate of elevation of PRL level and age of onset in the high-seizure frequency group were significantly higher than those in the low-seizure frequency group and control group （ P 〈 0.05 ）, and the rate of decline of P level in the high-sei- zure frequency group was significantly higher than that in the low-seizure frequency group （P 〈 0.05 ）. The combination therapy group had a significantly higher rate of elevation of T level than the monotherapy group （ P 〈 0.05 ）. Compared with the non-perimenstrual ep- ilepsy group, the perimenstrual epilepsy group had significantly higher rate of elevation of PRL level, rate of decline of P level, and E2/P ratio （P 〈 0.05 for all）. Conclusions Elevated PRL level is associated with recent seizures. The decline of P level is associat- ed with the severity of seizure. The levels of sex hormones are influenced by antiepileptic drugs, especially combination therapy with sodium valproate that has a marked impact on T level. P level and E2/P ratio are closely related to perimenstrual epilepsy, and P re- placement therapy may be an effective way to treat perimenstrual epilepsy.