目的 探討左乙拉西坦片聯(lián)合吡侖帕奈片治療兒童良性癲癇的臨床療效。方法 選取2020年5月-2021年12月聊城市第二人民醫(yī)院收治的78例良性癲癇患兒,按隨機數(shù)字表法將所有患者分為對照組和治療組,每組各39例。對照組口服吡侖帕奈片,起始劑量根據(jù)患兒體質(zhì)量>30 kg為2 mg/d、20~30 kg為1 mg/d,睡前吞服,每隔2周加量1次,每次加量為1個起始劑量,直至以4 mg/d的劑量維持治療。治療組在對照組基礎(chǔ)上口服左乙拉西坦片,起始劑量每次10 mg/kg,2次/d,每隔2周加量1次,每次加量為1個起始劑量(如第1次加量后劑量調(diào)整為每次20 mg/kg,2次/d),直至以每次30 mg/kg,2次/d的劑量維持治療。兩組療程均為6個月。觀察兩組的臨床療效,比較治療前后兩組癲癇發(fā)作情況、癇性放電率、事件相關(guān)電位P300潛伏期和波幅以及血清高遷移率族蛋白B1(HMGB1)、腫瘤壞死因子(TNF)-α、膠質(zhì)纖維酸性蛋白(GFAP)、γ-氨基丁酸(GABA)水平。結(jié)果 治療后,治療組總有效率是94.87%,顯著高于對照組的79.49%(P<0.05)。治療后,兩組癲癇發(fā)作頻率、NHS3評分均顯著降低,持續(xù)時間均顯著縮短(P<0.05);且以治療組降低更顯著(P<0.05)。治療后,兩組癇性放電率、P300潛伏期均顯著縮短,P300波幅均顯著增加(P<0.05);且以治療組改善更顯著(P<0.05)。治療后,兩組血清HMGB1、TNF-α、GFAP水平均顯著下降,血清GABA水平均顯著上升(P<0.05);且治療后,治療組血清HMGB1、TNF-α、GFAP、GABA水平均顯著優(yōu)于對照組(P<0.05)。結(jié)論 左乙拉西坦片聯(lián)合吡侖帕奈片治療兒童良性癲癇有確切療效,在控制患兒癲癇發(fā)作、減少癇性放電、改善認(rèn)知功能方面均可獲得較為滿意的效果,并可進一步降低血清HMGB1、TNF-α、GFAP水平及升高血清GABA水平,且安全性較好,值得臨床推廣應(yīng)用。

Objective To investigate the clinical efficacy of Levetiracetam Tablets combined with Perampanel Tablets in treatment of benign epilepsy in children. Methods A total of 78 children with benign epilepsy admitted to Liaocheng Second People's Hospital from May 2020 to December 2021 were selected and divided into control group and treatment group according to random number table method, with 39 cases in each group. Children in the control group were po administered with Perampanel Tablets, the initial dosage was 2 mg/d and 1 mg/d according to the body weight of the children (> 30 kg and 20-30 kg), respectively, swallowed before bed, and added once every 2 weeks, with one initial dosage each time, until the treatment was maintained at the dosage of 4 mg/d. Children in the treatment group were po administered with Levetiracetam Tablets on the basis of the control group, the initial dosage was 10 mg/kg each time, twice daily, and the dosage was added once every 2 weeks, each addition was 1 initial dosage (for example, the dosage was adjusted to 20 mg/kg each time, twice daily after the first addition), until the treatment was maintained at the dosage of 30 mg/kg each time, twice daily. The treatment course of both groups was 6 months. The clinical efficacy of the two groups was observed, and the seizure condition, epileptic discharge rate, event-related potential P300 latency and amplitude, and serum high mobility group protein B1 (HMGB1), tumor necrosis factor (TNF)-α, glial fibrillary acidic protein (GFAP), gamma-amine-butyric acid (GABA) levels were compared before and after treatment. Results After treatment, the total effective rate of the treatment group was 94.87%, which was significantly higher than that of the control group (79.49%, P < 0.05). After treatment, the frequency and NHS3 score of seizures in two groups were significantly decreased, and the duration was significantly shortened (P < 0.05). The decrease was more significant in treatment group (P < 0.05). After treatment, epileptic discharge rate and P300 latency were significantly shortened, and P300 amplitude was significantly increased in two groups (P < 0.05). The improvement was more significant in the treatment group (P < 0.05). After treatment, serum HMGB1, TNF-α and GFAP levels were significantly decreased, and serum GABA levels were significantly increased in two groups (P < 0.05). After treatment, serum levels of HMGB1, TNF-α, GFAP and GABA in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Levetiracetam Tablets combined with Perampanel Tablets has definite curative effect in treatment of benign epilepsy in children, and satisfactory effects can be obtained in controlling seizures, reducing epileptic discharge, and improving cognitive function in children, and can further reduce serum HMGB1, TNF-α, GFAP levels and increase serum GABA levels with good safety, which is worthy of clinical promotion and application.

R971；R985

山東省醫(yī)藥衛(wèi)生科技發(fā)展計劃項目(202006011279)