羚羊角颗粒联合左乙拉西坦治疗小儿癫痫的临床研究

Clinical study on Lingyangjiao Granules combined with levetiracetam in treatment of children with epilepsy

目的探讨羚羊角颗粒联合左乙拉西坦治疗小儿癫痫的临床效果。方法选取2014年10月-2018年7月苏州大学附属儿童医院和苏州科技城医院收治的癫痫患儿124例,随机分成对照组(62例)和治疗组(62例)。对照组口服左乙拉西坦片,起始剂量10 mg/(kg·d),2次/d,连用1周后以每周增加10 mg/(kg·d)的幅度调整剂量至30 mg/(kg·d),2次/d,维持治疗。治疗组在对照组基础上口服羚羊角颗粒,4~5岁2.5 g/次,5~10岁3.75 g/次,10~13岁5 g/次,2次/d。两组患者连续治疗6个月。观察两组患者临床疗效,同时比较治疗前后两组患者癫痫发作情况、动态脑电图(AEEG)监测结果、血清金属基质蛋白-9(MMP-9)、神经元特异性烯醇化酶(NSE)和S-100β水平以及儿童生活质量量表4.0(Peds QLTM4.0)量表评分。结果治疗后,对照组临床有效率为79.0%,显著低于治疗组的91.9%,两组比较差异有统计学意义(P<0.05)。治疗后,两组患者癫痫发作频率均显著降低(P<0.05),持续时间均显著缩短(P<0.05),且治疗组癫痫发作情况的改善效果显著好于对照组(P<0.05)。治疗后,两组患者AEEG显示痫性放电人数和总异常人数均显著低于治疗前(P<0.05),且治疗组明显少于对照组(P<0.05)。治疗后,两组患者血清MMP-9、NSE、S-100β水平均显著下降(P<0.05),且治疗组患者血清MMP-9、NSE、S-100β水平明显低于对照组(P<0.05)。治疗后,两组患者Peds QLTM4.0普适型家长代评量表中生理领域和心理社会领域评分及其总分均显著升高(P<0.05),且治疗组患者PedsQLTM4.0量表评分明显高于对照组(P<0.05)。结论羚羊角颗粒联合左乙拉西坦治疗小儿癫痫能有效稳定患儿病情,改善脑部异常放电,减轻脑组织损伤,提升患儿生活质量。

Objective To investigate the clinical effect of Lingyangjiao Granules combined with levetiracetam in treatment of children with epilepsy. Methods Children(124 cases) with epilepsy in Children’s Hospital of Suzhou University and the Affiliated Hospital Science & Technology Town Hospital of Nanjing Medical University from October 2014 to July 2018 were randomly divided into control(62 cases) and treatment(62 cases) groups. Children in the control group were po administered with Levetiracetam Tablets, the initial dose was 10 mg/(kg·d), twice daily, and adjusted to 30 mg/(kg·d) by increasing 10 mg/(kg·d) per week after one week of continuous use, twice daily. Children in the treatment group were po administered with Lingyangjiao Granules on the basis of the control group, 2.5 g/time for 4 - 5 years old children, 3.75 g/time for 5 - 10 years old children, 5 g/time for 10 - 13 years old children, twice daily. Children in two groups were treated for 6 months. After treatment, the clinical efficacy was evaluated, and the epileptic seizures, AEEG monitoring results, the serum levels of MMP-9, NSE, S-100β, and Peds QLTM 4.0 scale scores in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 79.0%, which was significantly lower than 91.9% in the treatment group, and there were differences between two groups(P < 0.05). After treatment, the seizure frequency in two groups was significantly decreased(P < 0.05), but duration of epilepsy was significantly shortened(P < 0.05), and the epileptic seizures situation in the treatment group was significantly better than those in the control group(P < 0.05). After treatment, the epileptic discharge and total abnormal persons of AEEG monitoring results in two groups were significantly reduced(P < 0.05), and the number in the treatment group was significantly less than that in the control group(P < 0.05). After treatment, the serum levels of MMP-9, NSE, S-100β in two groups were significantly decreased(P < 0.05), and these indicators level in the treatment group was significantly better than those in the control group(P < 0.05). After treatment, the total scores and scores of physiological and psychosocial field of Peds QLTM4.0 in two groups were significantly increased(P < 0.05), and the Peds QLTM 4.0 scale scores in the treatment group were significantly higher than those in the control group(P < 0.05). Conclusion Lingyangjiao Granules combined with levetiracetam in treatment of children with epilepsy can effectively stabilize the patient’s condition, improve abnormal brain discharge, reduce brain tissue damage, and improve the quality of life.