丙戊酸钠联合左乙拉西坦治疗癫痫疗效的Meta分析

Clinical Effect of Sodium Valproate Combined with Levetiracetam in the Treatment of Epilepsy:a Meta-analysis

目的系统评价丙戊酸钠(VPA)联合左乙拉西坦(LEV)治疗癫痫的疗效和安全性。方法检索万方数据资源系统、中国知网(CNKI)系列数据库、维普期刊资源中文数据库、Embase、PubMed、Cochrane英文数据库,获取VPA联合LEV治疗癫痫的随机对照试验(RCTs)有关文献,检索时限为各数据库建库至2021年8月;采用Cochrane风险偏倚评估工具对文献质量进行评价,使用Review Manager5.4.1软件进行数据的统计分析。结果共纳入15篇文献,包括13篇中文文献和2篇英文文献,共计1770例患者。分析结果表明,VPA联合LEV较单用VPA〔OR=4.66,95%Cl(3.40~6.38),P<0.00001〕或LEV〔OR=4.33,95%Cl(2.14~8.80),P<0.0001〕总有效率更高〔OR=4.60,95%Cl(3.45~6.41),P<0.00001〕;VPA联合LEV较单用VPA治疗癫痫,脑电图痫样改善较好〔OR=3.84,95%Cl(2.50~5.90),P<0.00001〕且癫痫发作次数〔SMD=-5.91,95%Cl(-8.35~3.47),P<0.00001〕和发作时间〔MD=-1.00,95%Cl(-1.19~0.80),P<0.00001〕均明显改善。结论本次研究结果表明,VPA联合LEV治疗癫痫与单用VPA或LEV相比,在提高临床疗效,降低不良反应发生率方面具有一定优势。但该结论仍需更多大样本,高质量的随机对照研究予以支持。

OBJECTIVE To systematically evaluate the efficacy and safety of sodium valproate(VPA)combined with levetiracetam(LEV)in the treatment of epilepsy.METHODS Randomized controlled trials of VPA combined with LEV in the treatment of epilepsy were obtained by searching Wanfang Data,CNKI,VIP,Embase、PubMed、Cochrane databases,and the retrieval time was set up until August 2021.The Cochrane risk bias assessment tool was used to evaluate the literature quality and Review Manager 5.4.1 software was used for statistical analysis.RESULTS A total of 15 literatures were included,including 13 Chinese literatures and 2 English literatures,with a total of 1770 patients.The results showed that the total efficiency of VPA combined with LEV was higher than VPA〔OR=4.66,95%Cl(3.40~6.38),P<0.00001〕or LEV〔OR=4.33,95%Cl(2.14~8.80),P<0.0001〕alone.Compared with VPA alone,VPA combined with LEV improved epileptic appearance in EEG〔OR=3.84,95%Cl(2.50~5.90),P<0.00001〕,the number〔SMD=-5.91,95%Cl(-8.35~3.47),P<0.00001〕and duration〔MD=-1.00,95%Cl(-1.19~0.80)of seizures were significantly improved.CONCLUSION The results of this study showed that VPA combined with LEV had certain advantages in improving clinical efficacy and reducing the incidence of adverse reactions compared with single drug.However,this conclusion still needs to be supported by more large-sample,high-quality randomized controlled studies.