癫痫患儿外周血单个核细胞主穹窿蛋白、P-糖蛋白的表达及左乙拉西坦的干预效果

Expressions of major vault protein and P-glycoprotein in peripheral blood mononuclear cells and effects of levetiracetam in treatment of children with epilepsy

目的探讨癫痫患儿外周血单个核细胞(PBMCs)主穹窿蛋白(MVP)、P-糖蛋白(P-gp)表达情况,并比较左乙拉西坦、丙戊酸钠对患儿外周血MVP、P-gp蛋白表达和认知功能的影响。方法选取2017年1月至2020年12月自贡市第四人民医院收治的良性癫痫患儿64例,采用随机数字表法分为观察组(32例)和对照组(32例)。对照组给予奥卡西平+丙戊酸钠治疗,观察组给予奥卡西平+左乙拉西坦治疗,两组均连续治疗6个月。评估两组临床疗效,采用蛋白免疫印迹法检测PBMCs的MVP、P-gp蛋白相对表达量,采用韦氏儿童智力量表评分评估认知功能,并进行比较。结果治疗6个月后,观察组总有效率为90.63%,高于对照组的75.00%,但差异无统计学意义(χ^(2)=2.744,P=0.098)。两组PBMCs的MVP、P-gp蛋白相对表达水平较治疗前下调,且观察组均低于对照组(P<0.05)。两组智商(IQ)、操作智商(PIQ)、语言智商(VIQ)及全量表智商(FIQ)评分较治疗前均升高,且观察组均高于对照组(P<0.05)。两组用药期间均未出现严重不良反应。结论MVP、P-gp可能参与癫痫的发生发展;左乙拉西坦可能通过下调患儿外周血MVP、P-gp表达,改善认知功能,发挥抗癫痫作用。但其联合奥卡西平能否提高抗癫痫疗效,尚待扩大样本量继续观察。

Objective To investigate the expressions of major vault protein(MVP)and P-glycoprotein(P-gp)in peripheral blood mononuclear cells(PBMCs)of children with epilepsy and compare the effects of levetiracetam and sodium valproate on the expressions of MVP and P-gp protein and cognitive function.Methods A total of 64 children with benign epilepsy treated in Zigong Fourth People’s Hospital from January 2017 to December 2020 were randomly divided into observation group and control group(n=32,each).Oxcarbazepine combined with sodium valproate was given in control group,and oxcarbazepine combined with levetiracetam was used in observation group.After continuous treatment for 6 months in both groups,the relative expression levels of MVP and P-gp protein were detected by Western blotting,and the cognitive function was evaluated by Wechsler intelligence scale for children(WISC).The clinical effects were compared and analyzed between two groups.Results After 6 months of treatment,there was no statistical difference in total effective rate between two groups,even though it was higher in observation group than that in control group(90.63%vs 75.00%,χ^(2)=2.744,P=0.098).Compared with those before treatment,the relative expression levels of MVP and P-gp protein in PBMCs decreased significantly after treatment in two groups,and they were lower in observation group than those in control group(P<0.05).The scores of intelligence quotient(IQ),performance IQ(PIQ),verbal IQ(VIQ)and full-scale IQ(FIQ)increased significantly compared with those before treatment in two groups and were higher in observation group than those in control group(P<0.05).There was no serious adverse reaction in both groups.Conclusion MVP and P-gp protein may be involved in the occurrence and development of epilepsy.Levetiracetam can improve cognitive function and play an anti-epileptic role by down-regulating the expressions of MVP and P-gp protein in PBMCs.However,whether the combination therapy of levetiracetam and oxcarbazepine can increase the antiepileptic effect remains to be observed by expanding the sample size.