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目的了解卡马西平(CBZ)、丙戊酸钠(VPA)、托吡酯(TPM)对患儿癫骨代谢的影响,探讨其发生机制,为临床制订防治措施提供理论依据。方法收集73例无肝、肾损害及其他特殊疾病、近期未应用糖皮质激素和治疗剂量VitD的癫患儿的血清和尿液,其中服药前的癫患儿13例作为对照组,CBZ组15例,VPA组15例,TPM组30例。测定其血清ALP和尿脱氧吡啶啉/尿肌酐(DPD/Cr),同时检测服用TPM的患儿血Ca2+、HCO3-水平。结果与对照组比较,CBZ组和TPM组血清ALP均显著增高(Pa<0.01),VPA组血清ALP与对照组比较无统计学差异(P>0.05);TPM组尿DPD/Cr与对照组比较差异有统计学意义(P<0.05),CBZ组和VPA组尿DPD/Cr与对照组比较无统计学差异(Pa>0.05)。TPM组、CBZ组、VPA组和对照组血清ALP与尿DPD/Cr之间均无相关性(r=-0.083、-0.036、-0.304、-0.396,Pa>0.05)。TPM组血Ca2+、HCO3-水平分别为(1.10±0.08)mmol.L-1、(16.28±1.09)mmol.L-1,均低于正常值。TPM组血Ca2+水平与ALP和DPD/Cr水平无相关性(r=-0.183、-0.288,Pa>0.05),血HCO3-水平与ALP和DPD/Cr水平亦无相关性(r=0.321、0.285,Pa>0.05),血Ca2+与HCO3-之间无相关性(r=-0.064,P>0.05)。结论 CBZ对骨代谢的影响主要体现在骨形成方面,服用CBZ的癫患儿应注意补充钙剂和VitD;VPA在短期内对骨代谢可能无影响;TPM对儿童骨代谢的影响包括骨形成和骨吸收2个方面,服用TPM的癫患儿不仅需要补充钙剂和VitD,而且还应定期检测血HCO3-水平。
Objective To investigate the effects of carbamazepine (CBZ), sodium valproate (VPA) and topiramate (TPM) on the epilepsy bone metabolism in children and to explore its mechanism and to provide a theoretical basis for clinical prevention and treatment. Methods Serum and urine of 73 children with epilepsy without liver, kidney damage and other special diseases who had not been treated with glucocorticoids and vitamin D were collected. Thirteen children with epilepsy before treatment were taken as control group. CBZ 15 in the group, 15 in the VPA group and 30 in the TPM group. The serum ALP and urine deoxypyridin / urinary creatinine (DPD / Cr) were measured and the levels of Ca2 + and HCO3- in blood were measured. Results Compared with the control group, serum ALP levels in CBZ group and TPM group were significantly increased (Pa <0.01), serum ALP levels in VPA group were not significantly different from those in control group (P> 0.05). Urinary DPD / Cr in TPM group was significantly higher than that in control group (P <0.05). There was no significant difference in urine DPD / Cr between CBZ group and VPA group and control group (P> 0.05). There was no correlation between serum ALP and urine DPD / Cr in TPM group, CBZ group, VPA group and control group (r = -0.083, -0.036, -0.304, -0.396, Pa> 0.05). The levels of Ca2 + and HCO3- in the TPM group were (1.10 ± 0.08) mmol.L-1 and (16.28 ± 1.09) mmol.L-1, respectively, which were lower than the normal values. There was no correlation between serum Ca2 + levels and ALP and DPD / Cr levels in TPM group (r = -0.183, -0.288, Pa> 0.05) , Pa> 0.05). There was no correlation between blood Ca2 + and HCO3- (r = -0.064, P> 0.05). CONCLUSION: CBZ affects bone metabolism mainly in bone formation. Calcium supplementation and VitD should be noted in epileptic children taking CBZ. VPA may have no effect on bone metabolism in short term. The effects of TPM on bone metabolism in children include bone formation And bone resorption in two aspects, taking TPM in children with epilepsy not only need to add calcium and VitD, but also should be regular testing of blood HCO3- levels.