小剂量托吡酯联合复方氨基丁酸维E对癫痫患儿的疗效分析

Analysis of efficacy of low-dose topiramate combined with compound aminobutyric acid and vitamin E on children with epilepsy

目的观察小剂量托吡酯联合复方氨基丁酸维E对小儿癫痫的症状、体征、神经认知功能、炎性因子及生活质量的影响。方法选取2016年5月至2019年5月在宣城市中心医院接受治疗的122例癫痫患儿为受试对象,采用随机数字表法将122例患儿分为观察组与对照组,各61例。对照组给予小剂量托吡酯治疗(初始剂量为1mg·kg^(-1)·d^(-1),之后每次加量0.5mg/kg,最高有效剂量为2~5mg·kg^(-1)·d^(-1),直到病情得以控制),观察组在对照组基础上予以复方氨基丁酸维E治疗。比较两组治疗前、治疗12周后的癫痫发作频率、持续时间、神经功能[交感神经皮肤反应(SSR)]、认知功能[中国修订版韦氏儿童智力量表(C-WISC)]、炎性因子[白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、超敏C-反应蛋白(hs-CRP)]及生活质量[儿童癫痫生存质量问卷(QOLCE)]的变化,并通过其治疗后的不良反应评估其用药安全性。结果两组简单性、复杂性部分性发作患儿托吡酯用量及所有患儿托吡酯总剂量比较均无统计学意义(P>0.05),观察组及对照组的复杂性部分性发作患儿托吡酯用量均明显高于简单性部分性发作患儿(t值分别为10.238、7.080,P<0.05)。治疗12周后,观察组、对照组患儿癫痫发作频率、发作持续时间、SSR潜伏期时长及IL-6、TNF-α、hs-CRP水平较治疗前均显著下降(t=6.752~50.950,P<0.05),且观察组上述指标明显低于对照组(t值分别为23.360、15.776、9.405、8.819、8.057、7.366,P<0.05)。治疗12周后,观察组和对照组的波幅、C-WISC量表(PIQ、VIQ、FIQ)各维度评分、QOLCE问卷(躯体功能、情感健康、行为能力、认知能力、社会功能)各维度评分、分量表(总体健康、自测)评分及总分较治疗前均有显著上升(t=7.161~48.669,P<0.05),且观察组上述指标明显高于对照组(t=4.514~24.519,P<0.05)。观察组不良反应总发生率为4.92%,而对照组为11.48%,两组差异无统计学意义(χ^(2)=0.899,P>0.05)。结论小剂量托吡酯联合复方氨基丁酸维E可以通过改善小儿癫痫患儿的认知功能及神经功能,降低局部炎症反应程度,从而有效缓解其癫痫发作频率及持续时间,促进生活质量的提高,对病情转归有利。

Objective To observe the effects of low-dose topiramate combined with compound aminobutyric acid and vitamin E on the symptoms,signs,neurocognitive function,inflammatory factors and quality of life of pediatric epilepsy.Methods A total of 122 children with epilepsy who were treated in the Xuancheng City Central Hospital from May 2016 to May 2019 were selected as the research subjects,and the 122 children were divided into the observation group and the control group according to the random number table method,with 61 cases in each group.The control group was given low-dose topiramate(with the initial dose of 1 mg·kg^(-1)·d^(-1),followed by an addition of 0.5 mg/kg each time and the maximum effective dose of 2-5 mg·kg^(-1)·d^(-1)until the disease was under control),and the observation group was treated with compound aminobutyric acid and vitamin E on the basis of the control group.The changes of epilepsy attack frequency and duration time,neurological function[sympathetic skin response(SSR)],cognitive function[Chinese revised Webster Intelligence Scale for Children(C-WISC)],inflammatory factors[interleukin-6(IL-6),tumor necrosis factor(TNF-α),hypersensitive C-reactive protein(hs-CRP)]and quality of life[Quality of Life in Childhood Epilepsy(QOLCE)]were compared between the two groups before treatment and after 12 weeks of treatment,and the safety of medication was evaluated by adverse reactions after treatment.Results There were no statistically significant differences in the topiramate dosages in children with simple and complex partial seizures between the two groups and the total dosages of topiramate among all children(P>0.05),and the topiramate dosages in children with complex partial seizures in the observation group and the control group were significantly higher than those in children with simple partial seizures(t=10.238 and 7.080,respectively,P<0.05).After 12 weeks of treatment,the epilepsy attack frequency and duration time,incubation period of SSR and levels of IL-6,TNF-αand hs-CRP in the observation group and the control group were significantly lower than those before treatment(t=6.752-50.950,P<0.05),and the above indexes in the observation group were significantly lower than those in the control group(t=23.360,15.776,9.405,8.819,8.057 and 7.366,respectively,P<0.05).After 12 weeks of treatment,the amplitude,scores of each dimension of C-WISC scale(PIQ,VIQ and FIQ),scores of each dimension of QOLCE questionnaire(physical function,emotional health,behavioral ability,cognitive ability and social function)and scores of subscales(general health and self-test)and total scores in the observation group and the control group were significantly higher than those before treatment(t=7.161-48.669,P<0.05),and the above indexes in the observation group were obviously higher than those in the control group(t=4.514-24.519,P<0.05).The total incidence rate of adverse reactions was 4.92%in the observation group,while 11.48%in the control group,and the difference between the two group was of no statistical significance(χ^(2)=0.899,P>0.05).Conclusion Low-dose topiramate combined with compound aminobutyric acid and vitamin E can reduce the local inflammatory response by improving the cognitive function and neurological function of children with epilepsy,so as to effectively alleviate the frequency and duration time of epilepsy attack and promote the improvement of quality of life,and it is favorable for disease outcomes.