标题：拉莫三嗪联合丙戊酸钠治疗难治性癫痫的疗效及对患者认知功能及外周血NSE、MBP的影响

      作者：章慧，郑东，方雅秀，侯乐    广州医科大学附属脑科医院神经内科，广东 广州 510370

      卷次： 2022年33卷7期

      【摘要】 目的 研究拉莫三嗪联合丙戊酸钠对难治性癫痫患者的临床疗效、认知功能及外周血神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)水平的影响。方法 选择2018年5月至 2020年5月于广州医科大学附属脑科医院就诊的60例难治性癫痫患者为研究对象，按随机数表法分为观察组和对照组，每组30例。对照组患者服用丙戊酸钠治疗，观察组患者在对照组治疗的基础上同时服用拉莫三嗪治疗，治疗6个月后比较两组患者的临床疗效，以及治疗前后的认知功能评分、外周血NSE、MBP因子水平，并统计两组治疗期间的药物不良反应发生情况。结果 观察组患者的临床治疗总有效率为93.33%，明显高于对照组的73.33%，差异有统计学意义(P<0.05)；治疗后，观察组患者的认知功能评分为(26.42±1.16)分，明显高于对照组的(25.19±2.35)分，差异有统计学意义(P<0.05)；治疗后，两组患者的NSE、MBP水平均较治疗前降低，且观察组患者的血清NSE、MBP水平分别为(10.71±3.40) μg/L、(8.15±3.69) μg/L，明显低于对照组的(14.24±3.03) μg/L、(10.41±3.06) μg/L，差异均有统计学意义(P<0.05)；观察组患者治疗期间的药物不良反应发生率为13.33%，明显高于对照组的发生率6.67%，差异有统计学意义(P<0.05)。结论 拉莫三嗪联合丙戊酸钠对难治性癫痫疗效确切，且可提升患者的认知水平，促进神经功能恢复，但可能引起不良反应。
      【关键词】 难治性癫痫；拉莫三嗪；丙戊酸钠；神经元特异性烯醇化酶；髓鞘碱性蛋白；认知功能；疗效
      【中图分类号】 R742.1 【文献标识码】 A 【文章编号】 1003—6350（2022）07—0872—03

Clinical efficacy of lamotrigine combined with sodium valproate in the treatment of patients with refractoryepilepsy and effect on cognitive function, peripheral blood neuron-specific enolase, and myelin basic proteinlevels.
ZHANG Hui, ZHENG Dong, FANG Ya-xiu, HOU Le. Department of Neurology, Brain Hospital Affiliated toGuangzhou Medical University, Guangzhou 510370, Guangdong, CHINA
【Abstract】 Objective To study the clinical efficacy of lamotrigine combined with sodium valproate in patientswith refractory epilepsy and its effect on cognitive function and peripheral blood neuron-specific enolase (NSE) and my-elin basic protein (MBP) levels.Methods A total of 60 patients with refractory epilepsy treated in Brain Hospital Affili-ated to Guangzhou Medical University between May 2018 and May 2020 were enrolled. They were divided into an ob-servation group (n=30) and a control group (n=30) according to random number table method. The control group wastreated with sodium valproate, while the observation group was treated with lamotrigine on the basis of the controlgroup. After 6 months of treatment, the clinical curative effect in the two groups were evaluated and compared. Scores ofcognitive function, levels of peripheral blood NSE and MBP before and after treatment in the two groups were com-pared. The adverse drug reactions during treatment in the two groups were recorded. Results The total response rate ofclinical treatment in the observation group was significantly higher than that in the control group (93.33% vs 73.33%, P<0.05). After treatment, the score of cognitive function in the observation group was significantly higher than that in con-trol group: (26.42±1.16) points vs (25.19±2.35) points, P<0.05. After treatment, levels of serum NSE and MBP in the twogroups were decreased, and levels of serum NSE and MBP in the observation group were significantly lower than thosein the control group (P<0.05): (10.71±3.40) μg/L vs (14.24±3.03) μg/L; (8.15±3.69) μg/L vs (10.41±3.06) μg/L. The inci-dence of adverse drug reactions during treatment in the observation group was significantly higher than that in the con-trol group (13.33% vs 6.67%, P<0.05). Conclusion The curative effect of lamotrigine combined with sodium valproateis significant on refractory epilepsy. It can improve cognitive level and promote the recovery of nerve function, but maycause adverse reactions.
      【Key words】 Refractory epilepsy; Lamotrigine; Sodium valproate; Neuron-specific enolase; Myelin basic pro-tein; Cognitive function; Curative effect