不同浓度左乙拉西坦对高热惊厥患儿病情复发 及血清相关指标的影响

Effect of levetiracetam with high and low concentrations on recurrence and serum related indicators in children with febrile convulsion

摘要:

目的 探讨不同浓度左乙拉西坦对高热惊厥患儿病情复发及血清相关指标的影响。方法 选取 2017 年3 月—2019 年2 月唐山市妇幼保健院收治的84 例高热惊厥患儿，根据左乙拉西坦的给药浓度不同，分 为A、B 组，每组42 例。A 组患儿自接诊入院首日予以左乙拉西坦口服15 mg/kg，2 次/d ；7 d 后逐渐减少 剂量，第8 ～ 12 天剂量减少至10 mg/kg，第13 ～ 15 天剂量减少至5 mg/kg，服药至16 d 时停止用药。B 组 患儿自接诊入院首日予以左乙拉西坦口服30 mg/kg，2 次/d ；7 d 后逐渐减少给药剂量，第8 ～ 12 天剂量减 少至10 mg/kg，第13 ～ 15 天剂量减少至5 mg/kg，服药至16 d 时停止用药。①两组患儿追踪随访期间，由专 人负责记录其发热频次、高热惊厥复发例数及复发频次。②利用视频脑电图等技术监测两组患儿治疗前及治 疗后6 个月的24 h 动态脑电图。③对两组患儿治疗前及治疗后6 个月末的血清神经元特异性烯醇化酶（NSE）、 酸性钙结合蛋白（S-100β）浓度进行检测。④比较两组患儿用药期间出现的不良事件发生情况。结果 两 组患儿发热频次、高热惊厥复发频次比较，差异无统计学意义（P >0.05）。两组患儿高热惊厥复发率比较，差 异无统计学意义（P >0.05）。两组患儿治疗后脑电图异常发生率比较，差异无统计学意义（P >0.05）。两组患 儿治疗前后NSE、S-100β 的差值比较，差异有统计学意义（P <0.05），A 组低于B 组。两组患儿不良事件总 发生率比较，差异无统计学意义（P >0.05）。结论 对高热惊厥患儿应用左乙拉西坦治疗，能有效防治高热惊厥， 且能改善异常脑电图的发生率，但是给药浓度的高低对临床疗效无明显影响。

关键词:恶性高热;惊厥，发热性;儿童;复发;血清学试验

Abstract:

Objective To analyze the effect of levetiracetam on relapse of febrile convulsions in children and serum related indexes. Methods Totally 84 children with febrile convulsions were treated in our hospital from March 2017 to February 2019. According to the different dosage of levetiracetam, the subjects were divided into group A and group B, 42 cases in each group. The children in group A were given levetiracetam orally on the first day of admission, and the dosage was 15 mg/kg, twice a day. After 7 days, the dosage was gradually reduced to 10 mg/kg from the eighth to twelfth day, to 5 mg/kg from the thirteenth to fifteenth day, and stopped on the sixteenth day. The children in group B were given levetiracetam orally on the first day of admission, the dosage was 30 mg/kg, twice a day. After 7 days, the dosage was gradually reduced to 10 mg/kg on the eighth to twelfth day, to 5 mg/kg on the thirteenth to fifteenth day, and stopped on the sixteenth day. ① During the follow-up period, the frequency of fever, the recurrence of febrile convulsions and the recurrence frequency were recorded. ② Video electroencephalogram was used to monitor 24-hour ambulatory electroencephalogram (AEEG) of two groups of children before and 6 months after treatment. ③ Serum levels of neuron-specific enolase and S-100beta protein were measured before treatment and at the end of 6 months after treatment in both groups. ④ Compare the occurrence of adverse events between the two groups. Results There was no significant difference in the frequency of fever and recurrence between group A and group B (P > 0.05); there was no significant difference in the recurrence rate of febrile convulsion between group A and group B (P > 0.05). There was no significant difference between group A and group B (P > 0.05). After treatment, NSE and S-100 β values in group A and group B were compared with those before treatment (P < 0.05). There was no significant difference in the incidence of adverse events between group A and group B (P > 0.05). Conclusion Levetiracetam can effectively prevent and treat febrile convulsions in children with febrile convulsions, and can improve the incidence of abnormal EEG, but the dosage concentration is almost the same in clinical effect.

Key words:malignant hyperpyrexia; seizures, febrile; child; recurrence; serologic tests