卡马西平联合通窍定痫汤治疗癫痫的临床研究

Clinical Research on Carbamazepine and Tongqiao Dingxian Decoction in the Treatment of Epilepsy

目的探讨卡马西平联合通窍定痫汤治疗癫痫的临床疗效及对病人血清神经肽Y(NPY)、脑源性神经营养因子(BD-NF)、胶质纤维酸性蛋白(GFAP)的影响。方法选择2014年1月—2017年1月我院就诊的96例癫痫病人,采用随机数字表法分为观察组(n=48)和对照组(n=48),对照组给予卡马西平治疗,观察组联合通窍定痫汤治疗,两组均连续治疗3个月。比较两组治疗前后血清NPY、BD-NF、GFAP和蒙特利尔认知评估量表(MoCA)、癫痫发作次数的变化,并比较临床疗效及不良反应。结果治疗后,两组血清NPY、BD-NF、GFAP较治疗前均显著降低(P <0.01);观察组血清NPY、BD-NF、GFAP均明显低于对照组(P <0.01)。治疗后,两组MoCA评分较治疗前均显著增加(P <0.01);观察组MoCA评分明显高于对照组(P <0.01)。治疗后,两组癫痫发作次数较治疗前均显著减少(P <0.01);观察组癫痫发作明显低于对照组(P <0.01)。观察组临床总有效率明显高于对照组(87.50%与60.42%,P <0.01)。观察组不良反应总发生率明显低于对照组(14.58%与47.92%,P <0.01)。结论癫痫病人采用卡马西平联合通窍定痫汤治疗效果显著,有助于减少癫痫发作次数,改善认知功能,其内在机制可能与抑制血清NPY、BD-NF、GFAP表达有关;且联合用药可降低不良反应,安全性高。

Objective To investigate the effect of carbamazepine and Tongqiao Dingxian decoction（TDD）in the treatment of epilepsy,and its effects on serum neuropeptide Y （NPY）,brain derived neurotrophic factor（BD-NF）and glial fibrillary acidic protein（GFAP）levels.Methods Ninety-ix patients with epilepsy in our hospital from January 2014 to January 2017 were randomly divided into two groups：control group （n=48）treated with carbamazepine and observation group（n=48）treated with carbamazepine and TDD for 3 months.The changes of serum NPY,BD-NF,GFAP,Montreal Cognitive Assessment（MoCA）,and the seizure frequency were compared between the two groups before and after treatment,and the clinical efficacy and adverse reactions were compared.ResultsAfter treatment,the levels of serum NPY,BD-NF,and GFAP were decreased in the two groups,which were significantly lower in the observation group than those in the control group（P〈0.01）.The MoCA scores were significantly increased in the two groups after treatment,which were significantly higher in the observation group than those in the control group（P〈0.01）.The seizure frequency was significantly reduced in the two groups after treatment,which was significantly lower in the observation group than that in the control group（P〈0.01）.The total effective rate was significantly higher in the observation group than that in the control group （87.50% vs 60.42%,P〈0.01）.The total incidence of adverse reactions in the observation group was significantly lower than that in the control group（14.58% vs 47.92%,P〈0.01）.ConclusionCarbamazepine and TDD can reduce the seizure frequency,improve cognitive function,reduce the adverse reactions in patients with epilepsy.It′s intrinsic mechanism may be related to the inhibition of the expression of serum NPY,BDNF,and GFAP.