丙戊酸对癫痫患者血浆纤维蛋白原水平的影响及相关因素分析

摘要

Objective: To explore the effects of valproic acid on the level of plasma fibrinogen (Fib) in epileptic patients and the related factors. Methods: The medical records of the inpatients with epilepsy who were treated with valproic acid in our hospital from January 1st2017 to March 1st2017 were collected, which included age, sexuality, height, body weight, clinical diagnosis, administration regimen of valproic acid, drug combination, lab results of liver function, blood routine, coagulation function and so on. The patients were divided into low Fib level group (< 2.0 g·L-1) and normal group. The risk factors related to low Fib level after administration of valproic acid were analyzed by multivariate Logistic regression method. ROC analysis was conducted to explore the predictor of low Fib level. Results: A total of 59 patients were enrolled into this study. There were 24 cases in low Fib level group and 35 cases in the normal group. Compared with results of normal group, the proportion of children, dose of valproic acid, the values of INR, PT and TT in low Fib level group were significantly higher (P < 0.05), while the values of NEUT%, RBC and PTA in low Fib level group were significantly lower (P < 0.05). All patients in low Fib level group didn't develop serious coagulation disorder and bleeding. So valproic acid continued and no symptomatic treatment was given to them. The results of Logistic regression analysis showed that dose of valproic acid [OR = 1.133, 95%CI(1.046, 1.227), P = 0.002) was the risk factor of Fib reduction caused by valproic acid. The results of ROC analysis showed that dose ≥ 13.311 7 mg·kg-1·d-1was an effect predictor for Fib reduction caused by valproic acid. Conclusion: Fib reduction induced by valproic acid were common in clinic. Close monitoring were needed for patients who took more than 13.311 7 mg·kg-1·d-1valproic acid.%目的:探讨丙戊酸对癫痫患者血浆纤维蛋白原(Fib)水平的影响及相关因素. 方法:收集2017年1月1日– 3月1日我院口服丙戊酸类药物治疗的癫痫住院患者的病历资料,记录患者年龄、性别、身高、体重、临床诊断、使用丙戊酸情况、合并用药情况、肝功能、血常规及凝血功能检测结果.将患者分为Fib降低组(＜ 2.0 g·L-1)和正常组,采用多元Logistic回归方法分析应用丙戊酸后出现Fib降低的危险因素,以受试者工作特性曲线(ROC)分析探索Fib降低的预测指标.结果:纳入研究的患者共计59例,Fib降低组24例,正常组35例.Fib降低组的儿童患者比例、剂量、INR、PT及TT均显著高于正常组;NEUT%、RBC、PTA显著低于正常组(P < 0.05).Fib降低组的患者均未出现严重的凝血功能障碍及出血表现,故未给予停药或对症处理.Logistic回归分析结果显示,剂量[OR = 1.133,95%CI (1.046,1.227),P = 0.002]是应用丙戊酸后出现Fib降低的危险因素.ROC分析表明,剂量≥ 13.311 7 mg·kg-1·d-1可有效预测Fib降低的发生风险. 结论:丙戊酸引起Fib降低的不良反应较为常见,对于剂量≥ 13.311 7 mg·kg-1·d-1的患者应加强监测.