癫痫患者脑脊液中K^(+)、Ca^(2+)水平变化及其临床监测价值的初步探讨

Preliminary study on levels of K^(+)and Ca^(2+)in cerebrospinal fluid of epilepsy patients and its clinical values

目的探讨癫痫患者脑脊液中K^(+)、Ca^(2+)水平变化及其作为临床监测指标的价值。方法选择首都医科大学宣武医院2021年1月至9月收治的癫痫患者65例作为疾病组,其中药物控制良好者35例,药物控制不良者30例;同期住院的头痛、头晕患者65例作为对照组。分别检测研究对象脑脊液及外周血清中K^(+)、Ca^(2+)水平,分析各组K^(+)、Ca^(2+)水平的差异,并分析血清及脑脊液中K^(+)、Ca^(2+)水平的相关性和脑脊液K^(+)、Ca^(2+)对癫痫临床用药监测的价值。结果癫痫组脑脊液K^(+)、Ca^(2+)水平均低于对照组(P均<0.05),药物控制不良组脑脊液K^(+)、Ca^(2+)水平均低于控制良好组和对照组(P均<0.05),控制良好组与对照组脑脊液K^(+)、Ca^(2+)水平差异均无统计学意义(P均>0.05)。癫痫组脑脊液K^(+)水平与血清K^(+)水平呈正相关(r=0.587,P<0.05)。当脑脊液K^(+)浓度截断值为2.67 mmol/L时,对癫痫药物控制不良与控制良好具有较好的鉴别诊断效率(敏感性为95.00%,特异性为89.47%);当脑脊液Ca^(2+)浓度截断值为1.16 mmol/L时,对癫痫药物控制不良与控制良好具有较好的鉴别诊断效率(敏感性为70.00%,特异性为63.16%)。结论脑脊液K^(+)、Ca^(2+)均可以作为癫痫药物治疗的监测指标,癫痫药物控制不良的患者会表现出更明显的脑脊液K^(+)、Ca^(2+)水平降低,用药期间除应监测血药浓度外还应密切关注脑脊液K^(+)、Ca^(2+)的变化趋势,以预防药物不良反应的发生。

Objective To discuss the levels of potassium(K^(+))and calcium(Ca^(2+))in cerebrospinal fluid(CSF)of epilepsy patients and its values as clinical monitoring index.Methods A total of 65 epilepsy patients diagnosed in Xuanwu Hospital of Capital Medical University from January 2021 to September were selected as the disease group,among them 35 were well controlled patients and 30 were poorly controlled patients.Another 65 patients with headache and dizziness in the same period were selected as the control group.The levels of K^(+)and Ca^(2+)in CSF and peripheral serum of the subjects in each group were detected respectively.The differences of the levels of K^(+)and Ca^(2+)in each group were analyzed.The correlation of the levels of K^(+)and Ca^(2+)in serum and CSF was observed.The diagnosis effects and the value of clinical medication monitoring of K^(+)and Ca^(2+)levels in CSF of epilepsy patients were analyzed.Results The levels of K^(+)and Ca^(2+)in CSF of epilepsy patients were significantly lower than those of the controls(P<0.05).The levels of K^(+)and Ca^(2+)in CSF of poorly controlled epilepsy patients were significantly lower than those of well-controlled epilepsy patients and controls(P<0.05).However,there were no significant differences of the levels of both K^(+)and Ca^(2+)in CSF between the well-controlled epilepsy patients and controls(P>0.05).There was a positive correlation of the K^(+)levels in CSF and serum of epilepsy patients(r=0.587,P<0.05).When the cut-off value of K^(+)concentration in CSF was 2.67 mmol/L,good diagnostic efficiencies of antiepilepsy drugs for both poorly and well-controlled patients were shown(sensitivity 95.00%and specificity 89.47%).When the cut-off value of Ca^(2+)concentration in CSF was 1.16 mmol/L,good diagnostic efficiencies of antiepilepsy drugs for both poorly and well-controlled patients were shown(sensitivity 70.00%and specificity 63.16%).Conclusion The levels of K^(+)and Ca^(2+)in CSF could be used as the monitoring indicators of therapeutic effects for antiepileptic drug.The poorly controlled patients may show more obvious decrease of K^(+)and Ca^(2+)levels in CSF.During the medication period of epilepsy,the close attention to the change trend of K^(+)and Ca^(2+)levels in CSF should also be paid to prevent the adverse reactions of drugs in addition to monitoring the blood concentration.