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目的:观察左乙拉西坦与托吡酯治疗原发性癫痫的疗效及安全性,并探讨其对患儿免疫功能的影响。方法:选择我院2013年3月至2015年6月收治的原发性癫痫患儿60例,随机分为左乙拉西坦组和托吡酯组各30例,另选同期体检的健康儿童30例作为对照组。三组儿童均采集晨起空腹静脉血(患儿分别于治疗前和治疗3个月时各采集1次),采用免疫比浊法检测血清免疫球蛋白IgG、IgA、IgM水平,采用流式细胞技术检测T淋巴细胞亚群CD3~+、CD4~+、CD8~+水平。观察治疗前后各组患儿免疫功能指标变化、临床疗效及不良反应。结果:治疗前两组患儿IgA、IgG、IgM、CD3~+、CD4~+及CD8~+水平与对照组比较,差异均有统计学意义(P均<0.05);治疗后两组患儿IgA、IgG、CD8~+和(或)CD4~+水平较治疗前明显改善(P均<0.05),且与对照组比较差异无统计学意义(P均>0.05),两组患儿之间比较差异也无统计学意义(P均>0.05)。治疗3个月后,左乙拉西坦组总有效率为93.33%,托吡酯组为86.67%,两组比较差异无统计学意义(P>0.05)。两组患儿治疗过程中均无明显电解质紊乱、血尿常规及肝肾功能检查异常,不良反应轻微,无停药病例。结论:癫痫患儿存在免疫功能异常,应用左乙拉西坦和托吡酯均能改善其免疫功能,且二者疗效相当,安全性较高,均具有较高的临床应用价值。
Objective: To observe the efficacy and safety of levetiracetam and topiramate in the treatment of primary epilepsy and to explore its effect on immune function in children. Methods: Sixty children with primary epilepsy who were treated in our hospital from March 2013 to June 2015 were randomly divided into two groups: levetiracetam group and topiramate group, 30 cases each, and 30 healthy children As a control group. The fasting venous blood collected from the morning of the three groups (children were collected before treatment and 3 months respectively), the levels of IgG, IgA and IgM in serum were detected by immunoturbidimetry, The levels of CD3 ~ +, CD4 ~ + and CD8 ~ + in T lymphocyte subsets were detected by real-time PCR. Changes of immune function, clinical efficacy and adverse reactions in each group before and after treatment were observed. Results: The levels of IgA, IgG, IgM, CD3 +, CD4 + and CD8 + in the two groups before treatment were significantly different from those in the control group (all P <0.05). After treatment, The levels of IgA, IgG, CD8 + and / or CD4 ~ + were significantly higher than those before treatment (all P <0.05), and there was no significant difference between the two groups (P> 0.05) The difference was not statistically significant (P all> 0.05). After 3 months of treatment, the total effective rate of levetiracetam group was 93.33%, and that of topiramate group was 86.67%. There was no significant difference between the two groups (P> 0.05). Two groups of children with no significant electrolyte imbalance in the course of treatment, hematuria and liver and kidney function tests abnormalities, mild adverse reactions, no discontinuation of the case. Conclusion: There is an abnormal immune function in children with epilepsy. Both levetiracetam and topiramate can improve their immune function. Both of them have the same curative effect and high safety, all of which have high clinical value.