左乙拉西坦对原发性癫痫患儿免疫功能和认知功能的影响

Effect of levetiracetam on immune function and cognitive function in children with primary epilepsy

目的观察左乙拉西坦与丙戊酸钠在原发性癫痫治疗中对患儿免疫功能和认知水平的影响。方法收集2016年1月至2017年6月于儿科收治确诊为原发性癫痫的患儿118例,随机数字表法分为两组各59例,对照组采用常规抗癫痫药物(丙戊酸钠)治疗,观察组使用左乙拉西坦治疗,均治疗1个疗程(12周)。测定两组患儿免疫功能水平:血清免疫球蛋白(IgA、IgG、IgM)及外周T淋巴细胞亚群水平(CD3^+、CD4^+、CD4^+/CD8^+)。记录患儿安静、清醒、卧位情况下脑电图四个频段相对功率,采用韦氏儿童智力测评量表对患儿认知功能进行测定。结果(1)观察组患儿临床疗效优于对照组,差异有统计学意义(Z=2.323,P=0.020);(2)治疗后两组血清IgA、IgG较治疗前显著降低(P均<0.05),且观察组低于对照组(P均<0.05);(3)治疗后两组CD3^+、CD4^+、CD4^+/CD8^+水平较治疗前显著上升(P均<0.05),且观察组高于对照组(P均<0.05);(4)与治疗前比较,治疗后两组患儿θ频段功率均显著降低(P均<0.05),且观察组θ频段功率低于对照组(P<0.05);(5)观察组语言测试中算数、词汇得分及操作测验项目中译码得分显著高于治疗前(P均<0.05),对照组操作测验中积木、译码得分显著低于治疗前(P均<0.05),观察组操作测验中积木、拼物、译码得分显著高于对照组(P均<0.05);治疗后对照组操作智商较观察组显著降低(P<0.05)。结论应用左乙拉西坦治疗小儿原发性癫痫,有效率较高,并能有效改善患儿的免疫功能,同时对患儿认知功能有一定改善。

Objective To compare the effect of levetiracetam and sodium valproate on the immune function and cognitive function in children with primary epilepsy. Methods A total of 118 children with definite primary epilepsy received and cured in from January 2016 to June 2017 were selected. The patients were divided into two groups（ n = 59 each） according to random number table： observation group and control group. Conventional antiepileptic drugs（ sodium valproate） was given in control group,and levetiracetam was given in observation group for one course all（ 12 weeks）. Clinical baseline data were recorded,and the levels of immune functions including serum immunoglobulin（Ig）A,IgG,IgM and T lymphocyte subsets（ CD3~＋,CD4~＋,CD4~＋/CD8~＋） in peripheral blood were detected. Relative powers of four frequency bands of electroencephalogram in quiet,sober,supine position were recorded. WLSC-CR was used to detect the cognitive functions.Results The clinical effect in observation group was better than that in control group（ Z = 2. 323,P = 0. 020）. The levels of serum Ig A and Ig G after treatment decreased in both two groups（ all P〈0. 05）,and they in observation group were significantly lower than those in control group（ all P〈0. 05）. The levels of CD3~＋,CD4~＋,CD4~＋/CD8~＋after treatment rised significantly in both two groups compared with pre-treatment（ all P〈0. 05）,and they were significantly higher in observation group than those in control group（ all P〈0. 05）. The power of θ frequency band after treatment in both two groups was significantly lower than that before treatment（ all P〈0. 05）,and the power of θ frequency band in observation group was significantly lower than that in control group（ P〈0. 05）. After treatment,the scores of count and vocabulary in language test items and the decoding score in operation test items in observation group were significantly higher than those before treatment（ all P〈0. 05）,and the scores of building blocks and decoding in control group were significantly lower than those before treatment（ all P〈0. 05）. The scores of building blocks,spelling and decoding in operation test items after treatment in observation group were significantly higher than those in control group（ all P〈0. 05）. After treatment,the performance intelligence quotient（ PIQ） in control group significantly decreased compared with observation group（ P〈0. 05）. Conclusion Levetiracetam has a higher effective rate for the treatment of primary epilepsy of children and can effectively improve the immune function and the cognitive function of children to a certain extent.