抗癫痫药物四种对中青年绝经前女性骨代谢的影响

Bone metabolism in premenopausal women with epilepsy on antiepileptic drug monotherapy

目的研究不同的常用抗癫痫药物对中青年女性骨代谢的影响。方法通过测量各组受试者的血清钙、25-羟基维生素D、碱性磷酸酶、甲状旁腺激素、胰岛素生长因子-1、胰岛素结合蛋白-3、骨密度等,分析长期单药服用不同抗癫痫药物如苯妥英钠(PHT)、卡马西平(CBZ)、丙戊酸钠(VPA)、左乙拉西坦(LEV)等对受试者骨代谢的影响。结果服用CBZ、PHT和VPA的受试者血清钙浓度低于服用LEV的受试者(P=0.002);服用PHT的受试者的ALP浓度显著高于服用CBZ、LEV和VPA的受试者(P=0.000);与LEV组相比,PHT组血清IGF-1水平降低(P=0.03);与LEV组相比,PHT组血清的IGFBP-3浓度显著降低(P=0.000)。结论抗癫痫药物会影响骨代谢,导致患者血清钙下降、骨量减低。LEV较其他抗癫痫药物对骨代谢的影响较小,但仍能造成患者碱性磷酸酶含量下降等。抗癫痫药物对中青年女性的骨代谢会产生一定影响,在临床用药过程中需监测相关指标。

Objective To study the effects of different antiepileptic drugs on bone metabolism in young and middle-aged premenopausal women.Methods To measure the levels of serum calcium,25-(OH)-D,alkaline phosphatase,parathyroid hormone,insulin growth factor I,insulin binding protein 3 and bone mineral density were measured in each group.Then analysed the effects of long-term single drug administration of different antiepileptic drugs such as phenytoin sodium(PHT),carbamazepine(CBZ),valproate sodium(VPA)and levetiracetam(LEV)on bone metabolism.Results The serum calcium concentration of the subjects taking CBZ,PHT was lower than that of the subjects taking LEV(P=0.002);the ALP concentration of the subjects taking PHT was significantly higher than that of the subjects taking CBZ,LEV and VPA(P=0.000);the serum IGF-1 level of the PHT group was lower than that of the LEV group(P=0.03);the serum IGFBP-3 concentration of the PHT group was significantly lower than that of the LEV group(P=0.000).Conclusion The antiepileptic drugs can affect bone metabolism in women,leading to the decrease of serum calcium and bone mass.Compared with other antiepileptic drugs,LEV has less effect on bone metabolism,but it can still reduce the content of alkaline phosphatase.The antiepileptic drugs have a certain impact on bone metabolism of young and middle-aged premenopausal women,and relevant indicators should be monitored in the process of clinical medication.