托吡酯对癫(癎)患儿骨代谢的影响

摘要

目的 探讨抗癫(癎)药托吡酯(topiramate,TPM)对癫(癎)患儿骨代谢的影响.方法 对单独服用托吡酯组32例、丙戊酸钠组45例和卡马西平组31例的癫(癎)患儿及36例未用药物治疗的癫(癎)患儿进行血钙、磷、碱性磷酸酶和骨密度的测定.结果 血钙浓度TPM组和VPA组均较对照组高,CBZ组则较对照组低(P均<0.05);血磷浓度TPM组与CBZ组均较正常对照组低(P<0.05),VPA组与对照组相比差异无统计学意义(P>0.05);血碱性磷酸酶各组间差异无统计学意义(P>0.05).骨密度测定,发现3个治疗组患儿均有不同程度的骨密度降低(P<0.05),并且和服药时间呈显著负相关.结论 新型抗癫(癎)药如托吡酯亦可导致癫(癎)患儿骨代谢异常,且骨密度与服药时间呈负相关.%Objective To assess bone metabolism in epileptic children treated with topiramate (TPM) and compared TPM with valproic acid ( VPA ) and carbamazepine ( CBZ ). Methods One hundred and eight epileptic children treated with TPM or VPA or CBZ and thirty-six healthy children had been recruited. The bone mineral density ( BMD ) at lumbar vertebrae ( L1-L4 ) and radius-ulna were evaluated by dual energy X-ray absorptiometry. The serum calcium, phosphorus, and alkaline phosphatase were also evaluated. Results Compared with healthy children, the serum calcium were higher in epileptic children treated with TPM and VPA, and lower in epileptic children treated with CBZ ( P ＜ 0.05 ); the serum phosphorus were lower in epileptic children treated with TMP and CBZ ( P ＜ 0.05 ),and no different in epileptic children treated with VPA (P ＞ 0.05 ). There were no differences in the serum alkaline phosphatase among epileptic children and healthy children (P ＞ 0.05 ). BMD was significantly reduced in epileptic children than in healthy children ( P ＜ 0.05 ), and degree of the reduction was negatively correlated with the duration of administration. Conclusions TPM effects the bone metabolism in epileptic children. The BMD of epileptic children was negatively correlated with the duration of administration.