定痫方加减联合左乙拉西坦治疗尿毒症血液透析相关性癫痫临床研究

Clinical research of modified Dingxian Formula combined with levetiracetam for hemodialysis-related epilepsy in uremia patients

目的观察定痫方加减联合左乙拉西坦治疗尿毒症血液透析相关性癫痫的临床疗效。方法将36例尿毒症血液透析相关性癫痫患者按照随机数字表法分为2组。治疗组18例予定痫方加减联合左乙拉西坦治疗,对照组18例予左乙拉西坦治疗,2组均连续治疗3个月。比较2组总有效率,治疗前后中医证候评分、癫痫发作频率及发作持续时间,血清中枢神经特异蛋白(S100β)、神经元特异性烯醇化酶(NSE)、丙二醛(MDA)和总抗氧化能力(T-AOC)水平。结果治疗组总有效率94.44%(17/18),高于对照组的77.78%(14/18)(P<0.05)。2组治疗后中医证候各项评分及总积分、癫痫发作频率均较本组治疗前降低(P<0.05),癫痫发作持续时间较本组治疗前缩短(P<0.05),且治疗后治疗组中医证候各项评分及总积分、癫痫发作频率低于对照组(P<0.05),癫痫发作持续时间短于对照组(P<0.05)。2组治疗后血清S100β、NSE、MDA水平均较本组治疗前降低(P<0.05),T-AOC水平均较本组治疗前升高(P<0.05),且治疗后治疗组S100β、NSE、MDA水平均低于对照组(P<0.05),T-AOC水平高于对照组(P<0.05)。结论定痫方加减联合左乙拉西坦治疗尿毒症血液透析相关性癫痫疗效良好,可改善患者中医证候表现,控制癫痫发作,其机制可能是通过干预功能失调的神经胶质细胞及纠正机体氧化/抗氧化失衡来发挥抗癫痫作用。

Objective To observe the clinical efficacy of modified Dingxian Formula combined with levetiracetam for hemodialysis-related epilepsy in uremia patients.Methods Totally 36 uremia patients with hemodialysis-related epilepsy were randomly divided into equal group,treatment group was treated with modified Dingxian Formula combined with levetiracetam,and control group with levetiracetam alone.Treatment continued 3 months,and the aim was to compare total effective rates,traditional Chinese medicine(TCM)syndrome score,seizure frequency and duration,serum central nervous system specific protein(S100β),neuron-specific enolase(NSE),malonaldehyde(MDA),Total antioxidant capacity(T-AOC).Results The total effective rates in treatment group were better than those in control group[94.44%(17/18)vs 77.78%(14/18),(P<0.05),respectively].After treatment,TCM syndrome score and seizure frequency in groups were decreased(P<0.05),which were decreased in treatment group than in cortrol group(P<0.05);seizure duration in groups was shorter as compared with before treatment(P<0.05),treatment group was shorter than control group(P<0.05);S100β,NSE and MDA in groups were decreased(P<0.05),improvement of which in treatment group were significantly better(P<0.05);T-AOC in groups was increased(P<0.05),treatment group was increased in comparison with control group(P<0.05).Conclusion For uremia patients with hemodialysis-related epilepsy,modified Dingxian Formula combined with levetiracetam has a good curative effect,which is capable improving TCM syndrome,and controlling seizures.Its mechanism may be to play a role through intervention of dysfunctional glial cells and correction of oxidation/anti-oxidation imbalance.