丙戊酸钠联合应用拉莫三嗪对癫痫患者血氨的影响

Effect of valproic acid coadministred with lamotrigine on epileptic patients'ammonia

目的回顾性分析丙戊酸钠(VPA)联合应用拉莫三嗪(LTG)对癫痫患者血氨的影响,评价癫痫患者血氨升高的影响因素。方法选取2018年5月—2020年4月于中山大学附属第七医院就诊的146例癫痫患者(包括新诊断癫痫患者),收集患者相关的临床资料,将其分为未使用抗癫痫药物组(A组)、单用VPA组(B组)和VPA联用LTG组(C组),比较患者的血氨指标。结果A组、B组和C组的平均血氨水平分别为(18.14±1.19)、(25.89±0.87)和(36.60±4.34)μmol/L,血氨高于正常值的发生率分别为2.77%、8.89%和20.0%。B组与A组及C组的差异具有统计学意义(P<0.05),C组与A组的差异具有统计学意义(P均<0.05)。结论癫痫患者使用VPA会有血氨增加的风险,在接受VPA治疗的患者中,同时使用LTG可能会有进一步增加血氨的风险。血氨的增加可能由多种因素引起,在临床上VPA与LTG联合用药时,应注意监测患者的血氨浓度,避免临床出现高氨血症状的出现。

Objective To investigate the effect of valproic acid(VPA)coadministred with lamotrigine(LTG)on epileptic patients'ammonia and evaluate the influencing factors of elevated blood ammonia in epileptic patients.Methods A retrospective analysis of clinical data from 146 patients with epilepsy(including newly diagnosed epilepsy patients)who were admitted to the Seventh Affiliated Hospital of Sun Yat-Sen University from May 2018 to April 2020 was performed.The patients were divided into no antiepileptic drug group(group A),VPA group only(group B)and VPA combined LTG group(group C),and the concentration of the blood ammonia of the patients were analyzed.Result The average ammonia levels in groups A,B and C were(18.14±1.19),(25.89±0.87)and(36.60±4.34)μmol/L,and the incidence of blood ammonia higher than normal were 2.77%,8.89%and 20.0%,respectively.The difference between group B and group A and group C were statistically significant(P<0.05),the difference between group C and group A was statistically significant(P<0.05).Conclusion Patients with epilepsy who use VPA were at increased risk of blood ammonia and LTG can increase ammonia in epileptic patients who were treated with VPA.So when VPA was combined with LTG,more attention should be paid to ammonia of patient to avoid adverse reactions.