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目的探讨丙戊酸钠(VPA)对不同发作类型癫痫患者白细胞毒性的影响。方法选取2013年5月—2015年7月围场满族蒙古族自治县医院收治的癫痫患者65例,按国际抗癫痫联盟制定的诊断标准和分类标准分为全面性强直阵挛发作(GTCS)组34例,单纯部分发作(SPS)组12例,单纯失神发作(SAS)组10例,SPS+GTCS组9例。4组患者均予以VPA治疗。观察4组患者血常规检查情况、治疗前后白细胞计数变化情况及临床疗效。结果 4组患者治疗后白细胞计数降低57例(87.7%);红细胞降低5例(7.7%),适当调整用药剂量后基本恢复至正常2例,因症状严重改用其他抗癫痫药治疗1例;血小板计数降低12例(18.5%),其中出现皮肤瘙痒2例,经对症处理后缓解;VPA导致血液毒性反应呈多样化,时间为7d~3年。4组患者治疗后白细胞计数低于治疗前,差异有统计学意义(P<0.05);治疗前后4组患者白细胞计数比较,差异无统计学意义(P>0.05)。4组患者痊愈24例,显效20例,有效10例,无效11例,总有效率为83.1%。结论 VPA治疗不同发作类型癫痫患者的临床疗效显著,白细胞计数与癫痫发作类型间无明显关联。
Objective To investigate the effect of sodium valproate (VPA) on leukocytotoxicity in patients with epilepsy. Methods Sixty-five patients with epilepsy admitted from May 2013 to July 2015 in Weichang Manchu and Mongolian Autonomous County Hospital were divided into 34 cases of generalized tonic-clonic seizure (GTCS) according to the diagnostic criteria and classification criteria set by International Antiepileptic Association , 12 cases in SPS group, 10 cases in SAS group and 9 cases in SPS + GTCS group. All 4 patients were treated with VPA. The blood routine examination was observed in 4 groups of patients, before and after treatment leukocyte count changes and clinical efficacy. Results After treatment, 57 patients (87.7%) decreased white blood cell count, 5 patients (7.7%) decreased erythrocyte after treatment, 2 patients returned to normal after appropriate dose adjustment, and 1 patient was treated with other antiepileptic drugs because of severe symptoms. Platelet count decreased in 12 cases (18.5%), which occurred in 2 cases of pruritus, relieved symptomatically; VPA led to a variety of hematological toxic reactions, the time was 7d ~ 3 years. The white blood cell count of the 4 groups of patients after treatment was lower than that before treatment, the difference was statistically significant (P <0.05). There was no significant difference in the white blood cell count between the 4 groups before and after treatment (P> 0.05). Four patients were cured in 24 cases, markedly effective in 20 cases, effective in 10 cases, ineffective in 11 cases, the total effective rate was 83.1%. Conclusions VPA is effective in treating patients with epilepsy of different seizure types. There is no significant correlation between leukocyte count and type of seizure.