丙戊酸治疗小儿癫痫的药理作用及影响因素

Pharmacological effect of valproic acid in the treatment of children with abnormal blood ammonia after epilepsy and analysis of its influencing factors

目的探讨丙戊酸单药治疗小儿癫痫后血氨异常的药理作用及影响因素。方法选取温州市中西医结合医院于2016年9月至2017年9月期间收治的187例癫痫患儿,所有患儿均接受了3个月以上的丙戊酸单药治疗。根据患儿服用后的血氨浓度将其划分为甲、乙、丙三组,其中甲组患儿血氨浓度正常(27~82μmol/L,共78例);乙组患儿血氨浓度异常(>82~119μmol/L,共65例);丙组患儿为高血氨患者(≥120μmol/L,共44例)。记录各组患儿的日服药剂量和心率、年龄、体重等情况,对比各组患儿服药前后的血氨浓度和肝功能变化情况及丙戊酸血药浓度等,分析影响癫痫患儿出现高血氨的相关因素。结果三组患儿在心率、日服药剂量、体重、年龄等方面均无明显差异(F值分别为0.537、0.164、0.092、0.113,均P>0.05)。甲组患儿中有1.28%的患儿出现肝损伤,有38.46%的患儿出现肝功能异常;乙组患儿中有7.69%的患儿出现肝损伤,有38.46%的患儿出现肝功能异常;丙组患儿中有13.63%的患儿出现肝损伤,有52.27%的患儿出现肝功能异常;三组患儿的肝功能异常情况比较并无明显差异(χ^2=2.341,P>0.05),丙组患儿的肝损伤发生率显著高于甲、乙两组患儿(χ^2值分别为7.939、4.302,均P<0.05)。丙戊酸浓度(OR=4.05,95%CI:2.018~8.374,P<0.05)和日服药剂量(OR=5.40,95%CI:2.837~10.273,P<0.05)、年龄(OR=2.87,95%CI:1.452~5.934,P<0.05)是影响癫痫患儿出现高血氨的相关危险因素。结论丙戊酸浓度和日服药剂量、年龄等都是影响癫痫患儿出现高血氨的相关因素,在对患儿使用丙戊酸单药治疗时应该注意药物剂量的使用。

Objective To analyze the pharmacological effect of valproic acid in the treatment of abnormal blood ammonia after epilepsy in children and its influencing factors.Methods 187 cases of children with epilepsy treated during the period from September 2016 to September 2017 in our hospital were selected for study.All children were treated for more than 3 months with valproic acid.Based on blood ammonia concentration after the children took the medicine,they were divided into Group A,Group B,and Group C,of which Group A showed normal blood ammonia concentration(27-82μmol/L,78 cases),group B showed abnormal changes(>82~119μmol/L,65 cases),and children in group C were high blood ammonia concentration patients(≥120μmol/L,44 cases).The daily dose,heart rate,age and weight of the children in each group were recorded,and the blood ammonia concentration,liver function change and blood valproic acid concentration before and after taking the medicine in each group were compared,and the related factors affecting the occurrence of high blood ammonia in the children with epilepsy were analyzed by Logistic regression.Results The three groups showed no significant differences in heart rate,daily dose,weight and age(F=0.537,0.164,0.092,0.113,respectively, P>0.05 for all).1.28% of the children in Group A had liver damage,and 38.46% had liver dysfunction.In Group B,7.69% of the children had liver damage,and 38.46% had liver dysfunction.In Group C,13.63% of the children had liver damage and 52.27% had liver dysfunction.There was no significant difference in abnormal liver function in the three groups(χ^2=2.341,P>0.05 for all),but the liver injury rate in Group C was significantly higher than that of Group A and Group B(χ~2=7.939,4.302,respectively,P<0.05 for all).The concentration of valproic acid(OR=4.05,95%CI:2.018-8.374,P<0.05),daily dose(OR=5.40,95%CI:2.837-10.273,P<0.05) and age(OR=2.87,95%CI:1.452-5.934,P<0.05) of the children were all related risk factors for hyperammonemia in epileptic children.Conclusion Valproic acid concentration,daily dose and age are the related factors that affect the occurrence of hyperammonia in epileptic children.The dosage of valproic acid should be a concern in the treatment of children with epilepsy by valproic acid.