接受卡马西平或丙戊酸单药治疗的儿童骨密度的评价。

I. Chou, K. Lin, Huei-Shyong Wang, Chao-jan Wang
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引用次数: 30

摘要

研究背景:抗癫痫药物已被证明与儿童和青少年时期骨密度降低有关,而这一时期正是骨骼矿化的关键时期。在青春期结束时达到的较低的峰值骨量与更大的更年期骨质疏松症和老年人骨折的风险相关。我们的目的是评估卡马西平与丙戊酸单药治疗对台湾儿童骨密度的影响。方法选取1995年11月至2005年4月间,接受卡马西平(n=21)或丙戊酸钠(n=21)单药治疗6个月以上的无并发症癫痫患儿42例。所有受试者年龄为5 ~ 18岁,无癫痫发作5个月以上,日常活动正常,饮食正常。采用双能x线骨密度仪测定L1 ~ L4腰椎骨密度。结果卡马西平和丙戊酸的平均血清水平分别为5.12 +/- 2.15 mcg/ml和49.61 +/- 20.84 mcg/ml。治疗时间分别为37.05 +/- 31.11个月和22.86 +/- 18.84个月。两组患者血清钙、磷酸盐水平均在治疗范围内。卡马西平组血清碱性磷酸酶水平(264.71 +/- 66.91,U/L)显著高于丙戊酸组(179.48 +/- 79.37,U/L)。卡马西平治疗组3例(140%)骨密度z -评分低于-2.0,丙戊酸治疗组无一例(p=0.232)。比较卡马西平和丙戊酸单药治疗儿童的Z-score,卡马西平治疗组有7例(33%)的Z-score在-1.5或更低,而丙戊酸治疗组没有Z-score在-1.5或更低(p=0.009)。在7例卡马西平治疗的z -1.5及以下儿童中,4例(57%)患者血清药物水平低于治疗范围。结论卡巴马西平单药治疗儿童骨密度低的发生率高于丙戊酸单药治疗儿童。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of bone mineral density in children receiving carbamazepine or valproate monotherapy.
BACKGROUND Antiepileptic drugs have been shown to be associated with a lowering of bone mineral density in childhood and adolescence, which are critical periods of skeletal mineralization. A lower peak bone mass attained at the end of adolescence is associated with greater involutional osteoporosis and risk for fracture in the elderly. Our purpose was to evaluate the effects of carbamazepine and valproate monotherapy on bone mineral density in children in Taiwan. METHODS From November 1995 to April 2005, forty-two children with uncomplicated epilepsy, who were treated with either carbamazepine (n=21) or valproate (n=21) monotherapy for more than 6 months, were enrolled in this study. All subjects were 5 to 18 years of age, seizure-free for 5 months or more, with normal daily activity, and normal diet. Lumbar bone mineral density of L1 to L4 was measured by dual-energy X-ray absorptiometry. RESULTS The mean serum levels of carbamazepine and valproate were 5.12 +/- 2.15 mcg/ml and 49.61 +/- 20.84 mcg/ml, respectively. Treatment durations were 37.05 +/- 31.11 months and 22.86 +/- 18.84 months, respectively. The serum levels of calcium and phosphate in both groups were within therapeutic range. The serum level of alkaline phosphatase was significantly higher in the carbamazepine group (264.71 +/- 66.91, U/L) than in the valproate group (179.48 +/- 79.37, U/L). Three patients (140%) had bone mineral density Z-score of -2.0 or lower in the carbamazepine-treated group, but none in the valproate-treated group (p=0.232). Comparing the Z-score in carbamazapine- and valproate-monotherapy children, 7 (33%) had Z-score of -1.5 or lower in the carbamazepine-treated group, and none in the valporate-treated group had Z-score of -1.5 or lower (p=0.009). Four (57%) patients in the 7 carbamazepine-treated children with Z-score of -1.5 or lower had serum drug level lower than therapeutic range. CONCLUSIONS Children receiving carbarmazepine monotherapy had increased frequency of lower bone density than children receiving valproate monotherapy.
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