目的 探討左乙拉西坦聯合地西泮對熱性驚厥反復發(fā)作兒童損傷因子、炎性因子和免疫因子的影響。方法 選擇唐山市婦幼保健院2016年6月-2018年4月收治的熱性驚厥患兒100例作為研究對象，按照隨機數字表法將患兒分為對照組（n=50）和觀察組（n=50）。對照組患兒口服復方地西泮片，40~200 μg/kg，3次/d，共7 d。觀察組在對照組的基礎上口服左乙拉西坦片，20 mg/kg，2次/d，熱退24 h后開始減量，以每2天減半量至第減藥期第7天停藥。兩組患兒出院后，均隨訪48周，每3個月隨訪1次。比較兩組患兒治療前后的腦損傷因子、炎性因子、免疫因子水平，同時觀察患兒發(fā)熱、熱性驚厥復發(fā)情況和不良反應發(fā)生情況。結果 治療后，兩組血清神經元特異性烯醇化酶（NSE）、核因子κB（NF-κB）和S100β蛋白水平均顯著降低，同組治療前后比較差異具有統計學意義（P<0.05）；治療后，觀察組血清NSE、NF-κB和S100β蛋白水平均顯著低于對照組，兩組比較差異具有統計學意義（P<0.05）。治療后，兩組血清腫瘤壞死因子-α（TNF-α）、白細胞介素-1β（IL-1β）和白細胞介素-10（IL-10）水平均顯著降低，同組治療前后比較差異具有統計學意義（P<0.05）；治療后，觀察組血清TNF-α、IL-1β和IL-10水平均顯著低于對照組，兩組比較具有統計學意義（P<0.05）。治療后，兩組血清免疫球蛋白（Ig）A、IgG、IgM水平均顯著降低，同組治療前后比較差異具有統計學意義（P<0.05）；治療后，觀察組血清IgA、IgG、IgM水平均顯著低于對照組，兩組比較具有統計學意義（P<0.05）。在治療和隨訪期間，觀察組患兒發(fā)熱、熱性驚厥復發(fā)情況和不良反應發(fā)生情況均優(yōu)于對照組（P<0.05）。結論 左乙拉西坦聯合地西泮治療小兒熱性驚厥可減少腦組織損傷，抑制炎性免疫反應，預防熱性驚厥反復發(fā)作，安全可靠，值得應用于小兒熱性驚厥的臨床治療。

Objective To investigate the effects of levetiracetam combined with diazepam on injury factors, inflammatory factors and immune factors in children with recurrent febric convulsion. Methods A total of 100 children with recurrent febric convulsion admitted to Tangshan Maternal & child Health Hospital from June 2016 to April 2018 were selected as the study subjects, and the children were divided into control group (n=50) and observation group (n=50) according to the random number table method. Patients in the control group were po administered with received Compound Diazepam Tablets, 40-200 μg/kg, three times daily, and treated for 7 d. Patients in the observation group were po administered with Levetiracetam Tablets on the basis of control group, 20 mg/kg, twice daily, the dosage began to decrease after 24 h of fever, and the dosage was halved every 2 days until the 7th day. After discharge, the two groups were followed up for 48 weeks, once every 3 months. After treatment, the levels of brain injury factor, inflammatory factor, and immune factor between two groups before and after treatment were compared. At the same time, the recurrent of fever and febrid convulsion, and adverse reactions were observed. Results After treatment, the serum levels of NSE, NF-κB, and S100β were significantly decreased in two groups, and the differences before and after treatment were statistically significant (P<0.05). After treatment, serum levels of NSE, NF-κB and S100β in the observation group were significantly lower than those in the control group, and the differences between two groups were statistically significant (P<0.05). After treatment, the serum levels of TNF-α, IL-1β, and IL-10 in two groups were significantly decreased, and the difference in te same group before and after treatment was statistically significant (P<0.05). After treatment, serum levels of TNF-α, IL-1β, and IL-10 in the observation group were significantly lower than those in the control group, and the comparison between two groups was statistically significant (P<0.05). After treatment, serum IgA, IgG and IgM levels in two groups were significantly reduced, and the difference in the same group before and after treatment was statistically significant (P<0.05). After treatment, serum IgA, IgG and IgM levels in the observation group were significantly lower than those in the control group, and the comparison between the two groups was statistically significant (P<0.05). During the treatment and follow-up period, the incidence of fever, convulsion recurrence, and adverse reactions in the observation group were better than those in the control group (P<0.05). Conclusion Levetiracetam combined with diazepam in treatment of febric convulsion in children can reduce brain injury, inhibit inflammatory immune response, and prevent repeated seizures of febric convulsion. It is safe and reliable, and is worthy of clinical application in the treatment of febric convulsion in children.

R971

河北省衛(wèi)生廳重點科技研究計劃項目（20181324）