癫痫患儿丙戊酸相关性高氨血症的临床研究

摘要

目的 探讨癫痫患儿服用丙戊酸(VPA)后高氨血症的发生情况及意义.方法 2006年1月至2010年6月青岛大学医学院附属医院儿科门诊、神经科门诊和病房单用VPA且资料完整的癫痫患儿78例,测量其用药后血氨的变化,分析伴或不伴症状的高氨血症与VPA药物剂量、药物浓度、癫痫病因的相关性.结果 单用VPA的癫痫患儿发生VPA相关性高氨血症21例,其中有症状者13例.特发性和隐源性癫痫(ICE)组中的血氨值明显高于症状性癫痫(SE)组(P<0.05),但服用VPA剂量及血VPA药物质量浓度均低于SE组(P<0.05).无症状-ICE组服用VPA剂量低于无症状一sE组(P<0.05)但血氨浓度和血VPA质量浓度与无症状-SE组差异无统计学意义(P>0.05);而有症状-ICE组血氨浓度高于有症状-SE组(P<0.05),但服用VPA剂量及血VPA质量浓度低于有症状-SE组(P<0.05).ICE组内与SE组内无论是否有症状,其血氨、服用VPA剂量和血VPA药物质量浓度差异皆无统计学意义(P>0.05).结论 临床医生应密切关注服用VPA的癫痫患儿,一旦发生高氨血症应予停药.%Objective To investigate the development of hyperammonemia and its significance in epilepsy children after taking valproate acid. Methods A total of 78 children with complete data who only took VPA were collected in the Affiliated Hospital of Qingdao University Medical College from Jan. 2006 to Jun. 2010. Compare the change of blood ammonia level before and after taking VPA in epileptic children and study the correlation between the hyperammonia with or without symptoms and dose and concentration of drug and the cause of epilepsy. Results Twenty-one cases had valproate associated hyperammonemia in 78 epileptic children using valproate only. The blood ammonia level in ICE group was significantly higher than SE group (P ＜ 0.05 ) ,but the dose and blood concentration of VPA was lower in ICE group (P ＜ 0.05).The dose of VPA was lower in the asymptomatic-lCE group than the asymptomatic-SE group (P ＜0.05) , but there was no difference between the asymptomatic-ICE group and the asymptomatic-SE group in blood ammonia leyel and concentration of VPA (P ＞ 0.05). The blood ammonia level was significantly higher in symptomatic-ICE group than symptomatic-SE group(P ＜ 0.05 ), but the dose and concentration of VPA were significantly lower(P ＜ 0.05) in the symptomatic-ICE group。 There were no differences between asymptomatic-ICE group and symptomatic-ICE group or the asymptomatic-SE group and symptomatic-SE group in the blood ammonia level and the dose and blood concentration of VPA (P ＞ 0.05 ). Conclusion Clinical physicians should pay close attention to the epilepsy children taking VPA, and once hyperammonemia oecurs, VPA administration should be stopped at once.