【摘要】

摘要：目的：探讨丙戊酸钠（Valproate，VAP）联合利培酮对癫痫性精神障碍患者血清25-(OH)D3、糖脂代谢与睡眠障碍的影响。
方法：纳入2016年4月至2018年12月南阳市中心医院神经内科收治的癫痫性精神障碍患者102例，按照随机数字表法分为观察组和对照组，各51例；观察组采用丙戊酸钠+利培酮治疗，对照组采用丙戊酸钠+安慰剂治疗，连续治疗3个月；采用简易精神状态量表（Mini-Mental State Examination，MMSE）、阳性与阴性症状量表（Positive and Negative Syndrome Scale ，PANSS）评估两组患者精神症状改善及认知功能情况；采用中文版匹兹堡睡眠质量指数表（Chinese Pittsburgh Sleep Quality Index，PSQI）评估患者睡眠障碍改善情况；检测两组患者治疗前后总胆固醇（Total cholesterol，TC）、甘油三酯（Triglyceride ，TG）、空腹血糖（Fasting blood glucose ，FBG）、血清25-(OH)D3水平，分析丙戊酸钠+利培酮对患者糖脂代谢和维生素D代谢情况。
结果：治疗后观察组PANSS阳性症状、阴性症状评分低于对照组，差异具有统计学意义（P<0.05）；观察组PSQI评分低于对照组，差异具有统计学意义（P<0.05）；治疗后两组患者血清25-(OH)D3水平均出现降低，观察组血清25-(OH)D3水平高于对照组，差异具有统计学意义（P>0.05）；两组患者治疗后TG、TC、FBG水平均出现升高，观察组TG、TC、FBG水平低于对照组，差异具有统计学意义（P>0.05）；副反应量表（TESS）显示，两组患者治疗期间不良反应发生率比较无统计学意义（P>0.05）。
结论：丙戊酸钠联合利培酮治疗癫痫性精神障碍具有良好的疗效，对于存在睡眠障碍的患者具有一定的改善作用；但使用过程中需要注意监测血脂、血糖、血钙浓度变化，减少不良反应。

【Abstract】

Abstract: Objective: To investigate the effects of valproate (VAP) combined with risperidone on serum 25- (OH) D3, glucose and lipid metabolism and sleep disorders in patients with epilepsy.
Methods: A total of 102 patients with epilepsy and mental disorders who were treated in the Department of Neurology, Nanyang Central Hospital from April 2016 to December 2018 were included. They were divided into observation group and control group according to the random number table method, with 51 cases each; The observation group was treated with sodium valproate + risperidone, and the control group was treated with sodium valproate + placebo for 3 consecutive months; Simplified mental state scale, positive and negative symptom scales were used to assess the improvement of symptoms and cognitive function of the two groups of patients; The Chinese version of the Pittsburgh Sleep Quality Index was used to assess the improvement of sleep disorders in patients; The total cholesterol, triglycerides, fasting blood glucose, and serum 25- (OH) D3 levels were measured before and after treatment in the two groups of patients, and the glucose and lipid metabolism and vitamin D metabolism of valproate + risperidone were analyzed.
Results: The scores of positive symptoms and negative symptoms of PANSS in the observation group were lower than those in the control group after treatment, and the difference was statistically significant (P<0.05); The PSQI score of the observation group was lower than that of the control group, and the difference was statistically significant (P<0.05); After treatment, the levels of serum 25- (OH) D3 in the two groups decreased, and the levels of serum 25- (OH) D3 in the observation group were higher than those in the control group, and the difference was statistically significant (P>0.05); After treatment, the levels of TG, TC, and FBG in the two groups increased. The levels of TG, TC, and FBG in the observation group were lower than those in the control group. The side effect scale (TESS) showed that the incidence of adverse reactions during treatment between the two groups of patients was not statistically significant (P>0.05).
Conclusion  : Sodium valproate combined with risperidone has a good curative effect on patients with epilepsy mental disorders, and it has a certain improvement effect on patients with sleep disorders; however, it is necessary to pay attention to monitoring changes in blood lipid, blood glucose and blood calcium concentration during use to reduce adverse reaction.