血清SIRT1表达对丙戊酸钠治疗癫痫患者疗效的影响

Effects of the expression of serum SIRT1 on therapeutic efficacy of sodium valproate in the treatment of epilepsy patients

目的 探索血清Sirtuin-1(SIRT1)表达对丙戊酸钠(VPA)治疗癫痫患者疗效的影响。方法 选择2021年3-10月贵州医科大学附属白云医院就诊的54例癫痫患者为研究对象,并同期选择50例健康者作为基线参考样本。将SIRT1 mRNA相对表达水平低于基线的患者作为SIRT1低表达治疗组,高于基线者作为SIRT1高表达治疗组。所有患者给予低剂量VPA(12 mg/kg或每日约600 mg)治疗3个月,并评价临床疗效;对癫痫控制无效的患者增加VPA药物剂量(15 mg/kg或每日约800 mg)再治疗3个月,作为SIRT1高表达加量组和SIRT1低表达加量组,并评价临床疗效。检测患者治疗3个月、加量治疗3个月后的血药浓度和肝功能指标。结果 治疗前,54例癫痫患者中有31例SIRT1低表达,23例SIRT1高表达。低剂量VPA治疗3个月后,在VPA有效血药浓度范围内,SIRT1高表达治疗组患者的有效控制率明显低于SIRT1低表达治疗组(P<0.05);加量治疗3个月后,SIRT1高表达加量组患者的有效控制率显著高于SIRT1高表达治疗组(P<0.05)。VPA治疗期间,患者肝功能指标未见异常。结论 在VPA有效血药浓度范围内治疗癫痫时,血清SIRT1高表达患者的癫痫可能更难控制;增加VPA剂量后,可提高癫痫发作的有效控制率。

OBJECTIVE To explore the effects of the expression of serum Sirtuin-1(SIRT1)on therapeutic efficacy of sodium valproate(VPA)in the treatment of epilepsy patients.METHODS Fifty-four epileptic patients were collected from the Affiliated Baiyun Hospital of Guizhou Medical University from Mar.to Oct.2021 as the research objects,and fifty healthy people were also collected during corresponding period as baseline reference samples.The patients whose relative mRNA expression of SIRT1 was lower than the baseline were selected as SIRT1 low-expression treatment group,and the patients whose that expression was higher than the baseline as SIRT1 high-expression treatment group.All patients were treated with low dose(12 mg/kg or about 600 mg/day)of VPA for 3 months,and the clinical efficacy was evaluated.The dosage of VPA in patients with ineffective epilepsy control should be increased to 15 mg/kg or about 800 mg/day for another 3 months as SIRT1 high-expression intensive treatment group and SIRT1 low-expression intensive treatment group.Clinical efficacies were evaluated.The blood concentration and liver function indexes of the patients were detected after 3 months of treatment and 3 months of intensive treatment.RESULTS Before treatment,among 54 epileptic patients,31 epileptic patients had low expression of SIRT1,and 23 had high expression of SIRT1.After 3 months of low-dose VPA treatment,within effective blood concentration of VPA,effective control rate of patients in SIRT1 high-expression treatment group was significantly lower than SIRT1 low-expression treatment group(P<0.05).After 3 months of intensive treatment,the effective control rate of patients SIRT1 high-expression intensive treatment group was significantly higher than SIRT1 high expression treatment group(P<0.05).No abnormality was found in liver function indexes during VPA treatment.CONCLUSIONS Epilepsy in patients with high expression of serum SIRT1 may be more difficult to control when VPA is within the effective blood concentration range;when the VPA dose is effectively increased,the effective control rate of epilepsy can be improved.