标题：左乙拉西坦联合奥卡西平治疗儿童难治性癫痫的疗效及对认知功能、神经损伤指标的影响

      作者：王沛，于乐，刘卫平    漯河市中心医院儿科一病区，河南 漯河 462300

      卷次： 2023年34卷17期

      【摘要】 目的 探讨左乙拉西坦联合奥卡西平治疗儿童难治性癫痫的疗效及其对患儿认知功能和神经损伤的改善作用。方法 选取 2020年 2月至 2022年 3月漯河市中心医院收治的 88例难治性癫痫为研究对象，按照随机数表法分为常规组和联合组各 44例。常规组患儿给予奥卡西平治疗，联合组患儿在此基础上给予左乙拉西坦治疗，均持续治疗6个月。比较两组患儿的临床疗效，以及治疗前、治疗6个月后的认知功能[脑电图各频段功率(α、β、δ、θ频段功率)]、炎症指标[C反应蛋白(CRP)、白细胞介素-6 (IL-6)、肿瘤坏死因子-α (TNF-α)]、神经损伤指标[Bcl-2相关X蛋白(Bax)、中枢神经特异性蛋白(S-100β)、半胱氨酸蛋白酶-3 (Caspase-3)、胶质纤维酸性蛋白(GFAP)]和治疗期间的不良反应发生情况。结果 联合组患儿的治疗总有效率为 93.18%，明显高于常规组的77.27%，差异有统计学意义(P<0.05)；联合组患儿治疗6个月后的脑电图α、β分别为(33.15±2.62) Hz、(14.76±2.43) Hz，明显高于常规组的(29.57±2.14) Hz、(12.57±2.10) Hz，δ、θ频段功率分别为(15.82±1.82) Hz、(19.34±1.75) Hz，明显低于常规组的(17.20±1.87) Hz、(21.56±1.93) Hz，差异均有统计学意义(P<0.05)；联合组患儿治疗6个月后的血清 IL-6、TNF-α、CRP水平分别为(2.13±1.13) pg/L、(2.35±0.85) μg/L、(16.81±2.53) mg/L，明显低于常规组的(3.28±1.25) pg/L、(3.00±0.93) μg/L、(20.43±2.75) mg/L，差异均有统计学意义(P<0.05)；联合组患儿治疗 6个月后的血清 S-100β、GFAP、Bax、Caspase-3水平分别为(0.45±0.08) μg/L、(1.74±0.53) ng/L、(8.54±1.78) pg/mL、(12.58±1.34) pg/mL，明显低于常规组的(0.62±0.10) μg/L、(2.24±0.85) ng/L、(10.33±1.82) pg/mL、(14.10±1.53) pg/mL，差异均有统计学意义(P<0.05)；治疗期间，联合组患儿的总不良反应发生率为 11.36%，略高于常规组的 6.82%，但差异无统计学意义(P>0.05)。结论 左乙拉西坦联合奥卡西平治疗难治性癫痫能有效减轻患儿的神经损伤，改善认知功能，抑制炎症反应，且安全可靠。
      【关键词】 儿童；难治性癫痫；左乙拉西坦；奥卡西平；神经损伤；认知功能
      【中图分类号】 R729 【文献标识码】 A 【文章编号】 1003—6350（2023）17—2513—05

Curative effect of levetiracetam combined with oxcarbazepine in the treatment of children with refractoryepilepsy and its influence on cognitive function and neurological injury indicators.
WANG Pei, YU Le, LIU Wei-ping.Ward Ⅰ, Department of Pediatrics, Luohe Central Hospital, Luohe 462300, Henan, CHINA
【Abstract】 Objective To explore the curative effect of levetiracetam combined with oxcarbazepine in the treat-ment of children with refractory epilepsy and its improvement effect on cognitive function and neurological damage inchildren. Methods A total of 88 patients with refractory epilepsy treated in Luohe Central Hospital from February2020 to March 2022 were selected as the research objects. According to random number table, they were divided into aconventional group and a combined group, with 44 patients in each group. The children in the conventional group weregiven oxcarbazepine, while the children in the combined group were given levetiracetam on this basis, continuously for6 months. The clinical efficacy, cognitive function [electroencephalography power of each frequency band (α, β, δ, θfrequency band power)], inflammation indicators [C reactive protein (CRP), interleukin 6 (IL-6), tumor necrosis fac-tor-α (TNF-α)], neurological injury indicators [Bcl-2 related X protein (Bax), central nervous system specific protein(S-100β), cysteine proteinase 3 (Caspase-3), glial fibrillary acidic protein (GFAP)] before and after 6 months of treatment,as well as the incidence of adverse reactions during treatment were compared between the two groups. Results The totaleffective rate in the combined group was 93.18%, which was significantly higher than 77.27% in the conventional group(P<0.05). After 6 months of treatment, the electroencephalography α- and β-band power in the combined group were(33.15±2.62) Hz, (14.76±2.43) Hz, which were significantly higher than (29.57±2.14) Hz, (12.57±2.10) Hz in the con-ventional group, while the δ- and θ-band power were (15.82± 1.82) Hz, (19.34 ±1.75) Hz, significantly lower than(17.20±1.87) Hz, (21.56±1.93) Hz in the conventional group (P<0.05). After 6 months of treatment, the serum IL-6,TNF-α, and CRP levels in the combined group were (2.13±1.13) pg/L, (2.35±0.85) μg/L, (16.81±2.53) mg/L, respective-ly, which were significantly lower than (3.28±1.25) pg/L, (3.00±0.93) μg/L, (20.43±2.75) mg/L in the conventionalgroup (P<0.05). After 6 months of treatment, the serum S-100β, GFAP, Bax, and Caspase-3 levels in the combinedgroup were (0.45±0.08) μg/L, (1.74±0.53) ng/L, (8.54±1.78) pg/mL, (12.58±1.34) pg/mL, respectively, which were sig-nificantly lower than (0.62±0.10) μG/L, (2.24±0.85) ng/L, (10.33±1.82) pg/mL, (14.10±1.53) pg/mL in the conventionalgroup (P<0.05). During the treatment period, the total incidence of adverse reactions in the combined group was 11.36%,which was slightly higher than 6.82% in the conventional group, but the difference was not statistically significant (P>0.05). Conclusion Levetiracetam combined with oxcarbazepine in the treatment of children with refractory epilepsycan effectively alleviate neurological damage, improve cognitive function, inhibit inflammatory reactions, which is safeand reliable.
      【Key words】 Children; Refractory epilepsy; Levetiracetam; Oxcarbazepine; Nerve injury; Cognitive function