目的 探讨拉莫三嗪联合吡仑帕奈治疗儿童癫痫的临床疗效。方法 收集2022年6月—2023年12月聊城市第二人民医院收治的136例癫痫患儿病例资料进行回顾性分析，按治疗方案不同分为对照组和治疗组，每组各68例。对照组睡前口服吡仑帕奈片，20～30 kg患儿1 mg/d，体质量＞30 kg患儿2 mg/d作为起始剂量，每次加1个起始剂量，加量周期为2周，到达4 mg/d的剂量时维持治疗。治疗组患者在对照组基础上口服拉莫三嗪片，年龄4～12岁者，初始剂量0.3 mg/(kg∙d)，1次/d（或分2次服用）连服2周，后按0.3 mg/(kg∙d)连服2周，1次/d（或分2次服用），此后每2周增加1次剂量，最大增加量≤0.6 mg/(kg∙d)，直至最佳疗效剂量，维持剂量一般在1～10 mg/(kg∙d)；年龄≥12岁者，初始剂量25 mg/次，1次/d，连服2周，后按50 mg/次连服2周，1次/d，此后每2周加量50 mg/d，直至最佳疗效，维持剂量一般在100～200 mg/d。两组患儿均治疗6个月。观察两组患儿临床疗效，比较治疗前后两组患儿癫痫发作频率和持续时间，健康相关生活质量特异性量表（QOLCE-16）和国立医院癫痫发作严重程度量表（NHS3）评分，脑电图指标α波功率、θ波功率、痫样放电数、累及导联数和棘波指数，及血清白细胞介素-6（IL-6）、基质金属蛋白酶-9（MMP-9）、谷氨酸（Glu）和神经元特异性烯醇化酶（NSE）水平。结果 治疗后，治疗组总有效率（95.59%）明显高于对照组（85.29%，P＜0.05）。治疗后，两组癫痫发作频率、持续时间、NHS3评分、痫样放电数、累及导联数、棘波指数及血清IL-6、MMP-9、Glu、NSE水平均低于同组治疗前（P＜0.05），且治疗后治疗组这些指标明显低于对照组（P＜0.05）。治疗后，两组QOLCE-16评分、α波功率和θ波功率均高于同组治疗前（P＜0.05），且治疗后治疗组明显高于对照组（P＜0.05）。结论 拉莫三嗪联合吡仑帕奈治疗儿童癫痫，能有效控制患儿癫痫发作，减轻机体炎症反应，抑制兴奋性神经递质紊乱及神经元损害，促进脑电异常活动及生活质量的改善。

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

山东省医药卫生科技发展计划项目（202006011279）