【摘要】

【摘要】目的 探讨左乙拉西坦与丙戊酸钠单药治疗成人初治局灶性癫痫的神经细胞因子及骨代谢的影响。
方法 将104例初治局灶性癫痫成人患者随机两组：对照组（n=52）予以丙戊酸钠单药治疗，观察组（n=52）予以左乙拉西坦添加治疗，疗程6个月。比较两组临床疗效、不良反应及复发率，治疗前及治疗后3、6个月，采用癫痫患者生活质量评定量表（QOLIE-31）评价生活质量，测定骨密度（BMD）、血钙、血磷、碱性磷酸酶（AKP）、甲状旁腺激素（PTH）、胶质纤维酸性蛋白（GFAP）、髓鞘碱性蛋白（MBP）和脑源性神经营养因子（BDNF）。
结果 治疗3、6个月末，观察组总有效率（80.77%、90.38%）与对照组（71.15%、82.69%）比较无明显差异（P>0.05）；治疗3、6个月末，两组QOLIE-31量表各维度评分均显著提高，且观察组综合生活质量、药物影响、认知功能维度评分及总评分显著高于对照组（P<0.05）；治疗3、6个月末，观察组血清GFAP、MBP显著低于对照组，BDNF显著高于对照组（P<0.05）；观察组BMD、血钙、血磷、AK、PTH无明显变化（P>0.05），对照组BMD明显降低而PTH明显升高（P<0.05）；观察组不良反应率显著低于对照组（P<0.05），两组复发率无明显差异（P>0.05）。
结论 左乙拉西坦单药治疗成人初治局灶性癫痫的疗效与丙戊酸钠相当，但副作用更少且对骨代谢的影响更轻，能够保护神经组织损伤并改善患者的生活质量。

【Abstract】

【Abstract】 Objective To investigate the influence of levetiracetam and sodium valproate on nerve factors and bone metabolism in adult patients with newly diagnosed partial epilepsy.
Methods 104 cases of adult patients with partial epilepsy were randomly divided into two groups:the control group (n = 52) was treated with sodium valproate,the observation group (n=52) was treated with levetiracetam for 6 months. The clinical efficacy,adverse reactions and recurrence rate between the two groups were compared.The quality of life was evaluated by Quality of Life in Epilepsy-31 Scale (QOLIE-31),the bone mineral density (BMD), serum calcium, phosphorus, alkaline phosphatase (AKP), parathyroid hormone (PTH), glial fibrillary acidic protein (GFAP), myelin basic protein (MBP) and brain-derived nerve nutrition factor (BDNF) were detected before and after treatment.
Results At the end of 3 and 6 months of treatment, the total effective rate in the observation group (80.77%,90.38%) and control group (71.15%,82.69%) were no significant differences (P>0.05). The scores of each dim ension of QOLIE-31 were significantly higher than those in the two groups,and the scores of comprehensive quality of life, drug impact, cognitive function dimension score and total score in observation group were significantly higher than the control group (P<0.05); The serum GFAP and MBP in the observation group were significantly lower than in the control group, and BDNF was significantly higher(P<0.05).There were no obvious changes of BMD, serum calcium, phosphorus, AK, and PTH in the observation group (P>0.05),while BMD in the control group was significantly decreased and PTH was significantly increased (P<0.05);The adverse reaction rate in the observation group were significantly lower than the control group (P<0.05),while the recurrence rate was no significant difference between the two groups (P>0.05).
Conclusion   The efficacy of levathracetam in treating adult newly diagnosed partial epilepsy is comparable to that of sodium valproate, but it has fewer side-effects and less effect on bone metabolism, it can protect nerve tissue and improve the patient's quality of life.