左乙拉西坦单药或联合用药治疗婴儿癫长程保留率的回顾性分析

Retrospective analysis the long-term retention rate of levetiracetam mono or combination therapy of infant epilepsy

目的：分析左乙拉西坦（LEV）单药或联合用药治疗婴儿癫的长程保留率。方法回顾性分析2006年7月至2007年6月应用LEV治疗的婴儿癫患儿的临床资料。结果60例服用LEV的癫患儿，部分性发作20例，全面性发作19例，癫综合征21例，其中难治性癫21例。23例LEV单药治疗，37例以LEV作为添加药物联合治疗。LEV首剂量10 mg/kg · d，每日2次口服，每周加量10 mg/kg，加量调整直至取得最佳疗效和耐受性。LEV治疗6个月、1年、2年、3年及4年的保留率分别为95.0%、75.0%、60.0%、51.7%和38.3%。最主要停药原因为缺乏疗效（43.2%）。COX回归模型提示，病程〉1个月（RR=2.91，95%CI：1.16~7.30）及难治性癫（RR=2.30，95%CI：1.22~4.32）是患儿停药的危险因素（P均〈0.05）。患儿服药后发作频率较基线水平明显减少（P〈0.01）。至随访结束，23例未停药患儿中，有效率100%，完全缓解率69.57%。主要不良反应为倦怠乏力（56.0%），其余为睡眠增多、烦躁不安等。结论 LEV单药或联合用药治疗婴儿癫具有较好的长程保留率、良好的疗效及耐受性。

Objective To analysis the long-term retention rate of Levetiraceram （LEV） monotherapy or combination therapy of infant epilepsy. Methods The clinical data of patients with infant epilepsy treated by LEV had been retrospectively analyzed from July 2006 to June 2007. Results Sixty patients with infant epilepsy treated by LEV had been recruited, 20 cases with partial seizures, 19 cases with generalized seizures, 21 cases with epilepsy syndrome. Among them 21 cases was intractable epilepsy. The retention rates of LEV in 6-month, 1-year, 2-year, 3-year and 4-year were 95.5%, 75.0%, 60.0%, 51.7%, and 38.3%. The most common reason for withdrawal was lack of effect （43.2%）. COX regression model suggested that duration〉1 month （RR=2.91, 95%CI：1.16~7.30） and refractory epilepsy （RR=2.30, 95%CI：1.22~4.32） were risk factors of withdrawal （all P〈0.05）. After treatment, the seizure frequency signiifcantly reduced compared with baseline （P〈0.01）. To the end of the follow-up, the efifciency was 100%and the complete remission rate was 69.57%in 23 cases continued treatment. The main side effect were fatigue （56.0%）, and sleep increased, irritability, and so on. Conclusions LEV monotherapy or combination therapy has well long-term retention rate, maintains well efifcacy and tolerability in infant epilepsy.