目的 探讨左乙拉西坦片联合吡仑帕奈片治疗儿童良性癫痫的临床疗效。方法 选取2020年5月-2021年12月聊城市第二人民医院收治的78例良性癫痫患儿,按随机数字表法将所有患者分为对照组和治疗组,每组各39例。对照组口服吡仑帕奈片,起始剂量根据患儿体质量>30 kg为2 mg/d、20~30 kg为1 mg/d,睡前吞服,每隔2周加量1次,每次加量为1个起始剂量,直至以4 mg/d的剂量维持治疗。治疗组在对照组基础上口服左乙拉西坦片,起始剂量每次10 mg/kg,2次/d,每隔2周加量1次,每次加量为1个起始剂量(如第1次加量后剂量调整为每次20 mg/kg,2次/d),直至以每次30 mg/kg,2次/d的剂量维持治疗。两组疗程均为6个月。观察两组的临床疗效,比较治疗前后两组癫痫发作情况、痫性放电率、事件相关电位P300潜伏期和波幅以及血清高迁移率族蛋白B1(HMGB1)、肿瘤坏死因子(TNF)-α、胶质纤维酸性蛋白(GFAP)、γ-氨基丁酸(GABA)水平。结果 治疗后,治疗组总有效率是94.87%,显著高于对照组的79.49%(P<0.05)。治疗后,两组癫痫发作频率、NHS3评分均显著降低,持续时间均显著缩短(P<0.05);且以治疗组降低更显著(P<0.05)。治疗后,两组痫性放电率、P300潜伏期均显著缩短,P300波幅均显著增加(P<0.05);且以治疗组改善更显著(P<0.05)。治疗后,两组血清HMGB1、TNF-α、GFAP水平均显著下降,血清GABA水平均显著上升(P<0.05);且治疗后,治疗组血清HMGB1、TNF-α、GFAP、GABA水平均显著优于对照组(P<0.05)。结论 左乙拉西坦片联合吡仑帕奈片治疗儿童良性癫痫有确切疗效,在控制患儿癫痫发作、减少痫性放电、改善认知功能方面均可获得较为满意的效果,并可进一步降低血清HMGB1、TNF-α、GFAP水平及升高血清GABA水平,且安全性较好,值得临床推广应用。

Objective To investigate the clinical efficacy of Levetiracetam Tablets combined with Perampanel Tablets in treatment of benign epilepsy in children. Methods A total of 78 children with benign epilepsy admitted to Liaocheng Second People's Hospital from May 2020 to December 2021 were selected and divided into control group and treatment group according to random number table method, with 39 cases in each group. Children in the control group were po administered with Perampanel Tablets, the initial dosage was 2 mg/d and 1 mg/d according to the body weight of the children (> 30 kg and 20-30 kg), respectively, swallowed before bed, and added once every 2 weeks, with one initial dosage each time, until the treatment was maintained at the dosage of 4 mg/d. Children in the treatment group were po administered with Levetiracetam Tablets on the basis of the control group, the initial dosage was 10 mg/kg each time, twice daily, and the dosage was added once every 2 weeks, each addition was 1 initial dosage (for example, the dosage was adjusted to 20 mg/kg each time, twice daily after the first addition), until the treatment was maintained at the dosage of 30 mg/kg each time, twice daily. The treatment course of both groups was 6 months. The clinical efficacy of the two groups was observed, and the seizure condition, epileptic discharge rate, event-related potential P300 latency and amplitude, and serum high mobility group protein B1 (HMGB1), tumor necrosis factor (TNF)-α, glial fibrillary acidic protein (GFAP), gamma-amine-butyric acid (GABA) levels were compared before and after treatment. Results After treatment, the total effective rate of the treatment group was 94.87%, which was significantly higher than that of the control group (79.49%, P < 0.05). After treatment, the frequency and NHS3 score of seizures in two groups were significantly decreased, and the duration was significantly shortened (P < 0.05). The decrease was more significant in treatment group (P < 0.05). After treatment, epileptic discharge rate and P300 latency were significantly shortened, and P300 amplitude was significantly increased in two groups (P < 0.05). The improvement was more significant in the treatment group (P < 0.05). After treatment, serum HMGB1, TNF-α and GFAP levels were significantly decreased, and serum GABA levels were significantly increased in two groups (P < 0.05). After treatment, serum levels of HMGB1, TNF-α, GFAP and GABA in the treatment group were significantly better than those in the control group (P < 0.05). Conclusion Levetiracetam Tablets combined with Perampanel Tablets has definite curative effect in treatment of benign epilepsy in children, and satisfactory effects can be obtained in controlling seizures, reducing epileptic discharge, and improving cognitive function in children, and can further reduce serum HMGB1, TNF-α, GFAP levels and increase serum GABA levels with good safety, which is worthy of clinical promotion and application.

R971；R985

山东省医药卫生科技发展计划项目(202006011279)