丙戊酸钠在精神疾病应用中致血浆纤维蛋白原降低的临床分析

Clinical analysis of decreased plasma fibrinogen induced by sodium valproate in psychiatric disorders

目的 研究丙戊酸钠在精神疾病应用中对纤维蛋白原(FIB)的影响。方法 回顾性分析18例精神疾病应用丙戊酸钠过程中出现血浆纤维蛋白原降低患者的临床资料,对比患者停药前后血浆纤维蛋白原水平,分析治疗及转归。结果 18例患者中,男5例,女13例;平均年龄(41.33±12.66)岁;精神分裂症12例,癫痫性精神病2例,双相情感障碍3例,精神障碍1例。患者均服用丙戊酸钠缓释片(规格:0.5 g/片),0.5 g/次,1~2次/d;丙戊酸钠用药持续时间(4.58±3.30)个月,停药时间(3.50±1.15)d。停药后,患者血浆纤维蛋白原水平为(2.79±0.66)g/L,高于停药前的(1.26±0.30)g/L,差异具有统计学意义(P<0.05)。18例患者住院期间常规进行凝血功能检查,发现血浆纤维蛋白原降低后均不再口服丙戊酸钠,其余精神科治疗方法不变。18例患者停药后复查血浆纤维蛋白原水平均恢复到>2.0 g/L。患者未出现出血及其他特殊不适。结论 丙戊酸钠在精神疾病的临床应用中个别患者可导致血浆纤维蛋白原降低,但未发现引起出血现象,停药后血浆纤维蛋白原可恢复正常。

Objective To study the effect of decreased plasma fibrinogen(FIB) induced by sodium valproate in psychiatric disorders.Methods The clinical data of 18 patients with decreased plasma fibrinogen during the treatment of sodium valproate were retrospectively analyzed.The plasma fibrinogen levels of patients before and after drug withdrawal were compared,and the treatment and outcome were analyzed.Results Among the 18 patients,there were 5 males and 13 females,with an average age of(41.33±12.66) years.There were 12 cases of schizophrenia,2 cases of epileptic psychosis,3 cases of bipolar disorder and 1 case of psychiatric disorder.All patients received valproate sustained-release tablets(specification:0.5 g/tablet),0.5 g/time,1-2 times/d;the duration of sodium valproate administration was(4.58±3.30) months,and the duration of withdrawal was(3.50±1.15) d.After drug withdrawal,the plasma fibrinogen level was(2.79±0.66) g/L,which was higher than that of(1.26±0.30) g/L before drug withdrawal,and the difference was statistically significant(P0.05).18 patients underwent routine coagulation function test during hospitalization,and it was found that the oral administration of sodium valproate was no longer adopted after plasma fibrinogen decrease,and the other psychiatric treatment methods remained unchanged.The mean plasma fibrinogen water of 18 patients recovered to 2.0 g/L after drug withdrawal,and no bleeding or other special discomfort occurred.Conclusion In the clinical use of sodium valproate in psychiatric disorders,plasma fibrinogenin decreased in individual patients,but no bleeding has been found,and it can return to normal after drug withdrawal.