丙戊酸钠联合拉莫三嗪对原发性癫痫患者外周血细胞因子与疗效的影响

Effects of sodium valproate combined with lamotrigine on levels of peripheral blood cytokines of patients with primary epilepsy

目的探讨丙戊酸钠与拉莫三嗪联用对原发性癫痫患者疗效、安全性及对外周血TNF-α、IL-2水平的影响。方法纳入2014年3月~2016年3月就诊于本院的确诊为原发性癫痫的患者150例,随机分为对照组和观察组,每组各75例,对照组采用丙戊酸钠单独给药,观察组予以丙戊酸钠联合拉莫三嗪给药。进行随访,比较两组脑电图结果好转时间及异常放电率、治疗后发作频次、自尊量表SES评价分数、外周血TNF-α、IL-2水平、总有效率及不良反应情况。结果观察组脑电图好转时间及异常放电率结果显著低于对照组(P<0.05);观察组3个月及6个月发作频次明显少于对照组(P<0.05);观察组的SES自尊评价平均分数显著高于对照组(P<0.05);两组患者治疗6个月后TNF-α、IFN-γ、IL-2、IL-6、IL-17A水平均比治疗前显著降低(P均<0.05),且观察组的TNF-α、IFN-γ、IL-2、IL-6、IL-17A水平均显著低于对照组(P均<0.05),但两组IL-10、IL-4、IL-23和IL-1β治疗前后无显著差异(P>0.05);观察组总有效率显著高于对照组(P<0.05);观察组不良反应出现率显著低于对照组(P<0.05)。结论丙戊酸钠与拉莫三嗪联合治疗原发性癫痫疗效确切,能更好地降低血TNF-α、IL-2水平,副作用较小,可在临床推广。

Objective To study the efficiency and safety of combination of valproate and lamotrigine in the treatment of epilepsy. Methods 150 patients with epilepsy from March, 2014 to March, 2016 were randomly divided into control group and observation group treated with sodium valproate and sodium valproate combined with lamotrigine, respectively. The EEG results, the frequency of seizures, the scores of SES, the levels of serum TNF-α and IL-2 and the adverse reaction were compared between the two groups,. Results The improvement of EEG and the proportion of abnorma 1 discharge in the observation group were significantly lower than those in the control group （P〈0.05）. The frequency of seizures in the observation group was significantly lower than that of the control group. The SES self-esteem scores of the observation group were significantly higher than those of the control group （P〈0.05）. The levels of TNF- α and IL-2 in the peripheral blood of the observation group were significantly lower than those in the control group （P〈 0.05）. The adverse reaction rate of the observation group was significantly lower than that of the control group （P〈 0.05）. Conclusion Valproic acid sodium combined with lamotrigine has a good and stable effect on the treatment of epilepsy, can reduce the levels of serum TNF-α and IL-2, efficiently, and has a smaller side effect.