左乙拉西坦联合地西泮对热性惊厥反复发作儿童损伤因子、炎性因子和免疫因子的影响

Effects of levetiracetam combined with diazepam on injury factor, inflammatory factor, and immune factor of children with recurrent febric convulsion

目的探讨左乙拉西坦联合地西泮对热性惊厥反复发作儿童损伤因子、炎性因子和免疫因子的影响。方法选择唐山市妇幼保健院2016年6月—2018年4月收治的热性惊厥患儿100例作为研究对象,按照随机数字表法将患儿分为对照组(n=50)和观察组(n=50)。对照组患儿口服复方地西泮片,40~200μg/kg,3次/d,共7 d。观察组在对照组的基础上口服左乙拉西坦片,20 mg/kg,2次/d,热退24 h后开始减量,以每2天减半量至第减药期第7天停药。两组患儿出院后,均随访48周,每3个月随访1次。比较两组患儿治疗前后的脑损伤因子、炎性因子、免疫因子水平,同时观察患儿发热、热性惊厥复发情况和不良反应发生情况。结果治疗后,两组血清神经元特异性烯醇化酶(NSE)、核因子κB(NF-κB)和S100β蛋白水平均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,观察组血清NSE、NF-κB和S100β蛋白水平均显著低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和白细胞介素-10(IL-10)水平均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,观察组血清TNF-α、IL-1β和IL-10水平均显著低于对照组,两组比较具有统计学意义(P<0.05)。治疗后,两组血清免疫球蛋白(Ig)A、IgG、IgM水平均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,观察组血清IgA、IgG、IgM水平均显著低于对照组,两组比较具有统计学意义(P<0.05)。在治疗和随访期间,观察组患儿发热、热性惊厥复发情况和不良反应发生情况均优于对照组(P<0.05)。结论左乙拉西坦联合地西泮治疗小儿热性惊厥可减少脑组织损伤,抑制炎性免疫反应,预防热性惊厥反复发作,安全可靠,值得应用于小儿热性惊厥的临床治疗。

Objective To investigate the effects of levetiracetam combined with diazepam on injury factors, inflammatory factors and immune factors in children with recurrent febric convulsion.Methods A total of 100 children with recurrent febric convulsion admitted to Tangshan Maternal & child Health Hospital from June 2016 to April 2018 were selected as the study subjects, and the children were divided into control group(n=50) and observation group(n=50) according to the random number table method.Patients in the control group were po administered with received Compound Diazepam Tablets, 40 — 200 μg/kg, three times daily,and treated for 7 d.Patients in the observation group were po administered with Levetiracetam Tablets on the basis of control group,20 mg/kg, twice daily, the dosage began to decrease after 24 h of fever, and the dosage was halved every 2 days until the 7 th day.After discharge, the two groups were followed up for 48 weeks, once every 3 months.After treatment, the levels of brain injury factor, inflammatory factor, and immune factor between two groups before and after treatment were compared.At the same time, the recurrent of fever and febrid convulsion, and adverse reactions were observed.Results After treatment, the serum levels of NSE,NF-κB, and S100β were significantly decreased in two groups, and the differences before and after treatment were statistically significant(P < 0.05).After treatment, serum levels of NSE, NF-κB and S100β in the observation group were significantly lower than those in the control group, and the differences between two groups were statistically significant(P < 0.05).After treatment, the serum levels of TNF-α, IL-1β, and IL-10 in two groups were significantly decreased, and the difference in te same group before and after treatment was statistically significant(P < 0.05).After treatment, serum levels of TNF-α, IL-1β, and IL-10 in the observation group were significantly lower than those in the control group, and the comparison between two groups was statistically significant(P < 0.05).After treatment, serum IgA, IgG and IgM levels in two groups were significantly reduced, and the difference in the same group before and after treatment was statistically significant(P < 0.05).After treatment, serum IgA, IgG and IgM levels in the observation group were significantly lower than those in the control group, and the comparison between the two groups was statistically significant(P < 0.05).During the treatment and follow-up period, the incidence of fever, convulsion recurrence, and adverse reactions in the observation group were better than those in the control group(P < 0.05).Conclusion Levetiracetam combined with diazepam in treatment of febric convulsion in children can reduce brain injury, inhibit inflammatory immune response, and prevent repeated seizures of febric convulsion.It is safe and reliable, and is worthy of clinical application in the treatment of febric convulsion in children.