目的 探討拉莫三嗪聯(lián)合吡侖帕奈治療兒童癲癇的臨床療效。方法 收集2022年6月—2023年12月聊城市第二人民醫(yī)院收治的136例癲癇患兒病例資料進(jìn)行回顧性分析，按治療方案不同分為對(duì)照組和治療組，每組各68例。對(duì)照組睡前口服吡侖帕奈片，20～30 kg患兒1 mg/d，體質(zhì)量＞30 kg患兒2 mg/d作為起始劑量，每次加1個(gè)起始劑量，加量周期為2周，到達(dá)4 mg/d的劑量時(shí)維持治療。治療組患者在對(duì)照組基礎(chǔ)上口服拉莫三嗪片，年齡4～12歲者，初始劑量0.3 mg/(kg∙d)，1次/d（或分2次服用）連服2周，后按0.3 mg/(kg∙d)連服2周，1次/d（或分2次服用），此后每2周增加1次劑量，最大增加量≤0.6 mg/(kg∙d)，直至最佳療效劑量，維持劑量一般在1～10 mg/(kg∙d)；年齡≥12歲者，初始劑量25 mg/次，1次/d，連服2周，后按50 mg/次連服2周，1次/d，此后每2周加量50 mg/d，直至最佳療效，維持劑量一般在100～200 mg/d。兩組患兒均治療6個(gè)月。觀察兩組患兒臨床療效，比較治療前后兩組患兒癲癇發(fā)作頻率和持續(xù)時(shí)間，健康相關(guān)生活質(zhì)量特異性量表（QOLCE-16）和國立醫(yī)院癲癇發(fā)作嚴(yán)重程度量表（NHS3）評(píng)分，腦電圖指標(biāo)α波功率、θ波功率、癇樣放電數(shù)、累及導(dǎo)聯(lián)數(shù)和棘波指數(shù)，及血清白細(xì)胞介素-6（IL-6）、基質(zhì)金屬蛋白酶-9（MMP-9）、谷氨酸（Glu）和神經(jīng)元特異性烯醇化酶（NSE）水平。結(jié)果 治療后，治療組總有效率（95.59%）明顯高于對(duì)照組（85.29%，P＜0.05）。治療后，兩組癲癇發(fā)作頻率、持續(xù)時(shí)間、NHS3評(píng)分、癇樣放電數(shù)、累及導(dǎo)聯(lián)數(shù)、棘波指數(shù)及血清IL-6、MMP-9、Glu、NSE水平均低于同組治療前（P＜0.05），且治療后治療組這些指標(biāo)明顯低于對(duì)照組（P＜0.05）。治療后，兩組QOLCE-16評(píng)分、α波功率和θ波功率均高于同組治療前（P＜0.05），且治療后治療組明顯高于對(duì)照組（P＜0.05）。結(jié)論 拉莫三嗪聯(lián)合吡侖帕奈治療兒童癲癇，能有效控制患兒癲癇發(fā)作，減輕機(jī)體炎癥反應(yīng)，抑制興奮性神經(jīng)遞質(zhì)紊亂及神經(jīng)元損害，促進(jìn)腦電異?；顒?dòng)及生活質(zhì)量的改善。

Objective To explore the clinical efficacy of lamotrigine combined with pirepane in treatment of childhood epilepsy. Methods The clinical data of children (136 cases) with epilepsy in the Second People's Hospital of Liaocheng from June 2022 to December 2023 were analyzed retrospectively. They were divided into control and treatment group based on different treatments, and each group had 68 cases. Children in the control group were po administered with Perampanel Tablets before bed, 1 mg/d for children of 20 — 30 kg, 2 mg/d for children of more than 30 kg as the initial dose, 1 initial dose was added each time for 2 weeks, until 4 mg/d as a maintenance dose. Children in the treatment group were po administered with Lamotrigine Tablets based on the control group, 0.3 mg/(kg∙d) for 4 — 12 years children, once daily, after that, the dose was increased every 2 weeks, with the maximum increase of ≤ 0.6 mg/(kg∙d) until the optimal therapeutic dose, the maintenance dose was generally 1 — 10 mg/(kg∙d). For those aged ≥ 12 years, the initial dose was 25 mg/time for 2 weeks, once daily, and then 50 mg/time, and then 50 mg/day would be added every 2 weeks until the best effect was achieved. The maintenance dose was generally 100 — 200 mg/d. Patients in two groups were treated for 6 months. After treatment, the clinical evaluations were evaluated, the seizure frequency and duration, QOLCE-16 and NHS3 scores, EEG indicators of alpha wave power, theta wave power, number of epileptiform discharges, number of leads involved and spike wave index, the levels of IL-6, MMP-9, Glu, and NSE in two groups before and after treatment were compared. Results After treatment, the total effective rate in the treatment group (95.59%) was higher than that in the control group (85.29%, P < 0.05). After treatment, the seizure frequency, duration, NHS3 score, number of epileptiform discharges, number of leads involved, spike index and serum IL-6, MMP-9, Glu, and NSE levels in two groups were lower than those before treatment in the same group (P < 0.05), and these indicators in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the QOLCE-16 score, α wave power and θ wave power in two groups were higher than those in the same group before treatment (P < 0.05), and after treatment, these indicators in the treatment group were significantly higher than that in the control group (P < 0.05). Conclusion Treating childhood epilepsy with lamotrigine combined with pirampanet can effectively control seizures in children, reduce the inflammatory response, inhibit excitatory neurotransmitter disorders and neuron damage, and promote abnormal EEG activity and improvement of quality of life.

R985

山東省醫(yī)藥衛(wèi)生科技發(fā)展計(jì)劃項(xiàng)目（202006011279）