摘要
目的:探讨丙戊酸引起癫痫患者纤维蛋白原减少的相关因素。方法:采用回顾性调查的方法,选取2017年1月1日-2017年3月1日首都医科大学宣武医院癫痫诊疗中心规律服用临床常规剂量丙戊酸1周以上的癫痫患者,收集患者的一般情况,用药情况(丙戊酸剂量、丙戊酸剂型、合并用药),肝功能、血常规、凝血功能等指标,采用单因素和二项Logistic回归分析上述因素与发生纤维蛋白原减少之间的相关性,并用受试者工作特征曲线(ROC曲线)筛选预测纤维蛋白原减少敏感度和特异度均较好时的因素切点值。结果:本次调查的有效病例共59例,其中男性40例(67.8%)、女性19例(32.2%);14岁及以下35例(59.3%)、14岁以上24例(40.7%),平均年龄(17.2±15.7)岁;有24例(40.7%)发生纤维蛋白原减少。单因素分析结果显示,纤维蛋白原减少与患者年龄呈负相关(P=0.042),与丙戊酸剂量呈正相关(P=0.003),与患者性别(P=0.679)、丙戊酸剂型(P=0.790)及合并用药(P=0.502)无关;二项Logistic回归分析显示丙戊酸剂量及患者的中性粒细胞百分比、红细胞计数和血小板计数是引发纤维蛋白原减少的相关危险因素,其相关危险因素比值比分别为1.101、0.925、0.132、0.976;ROC曲线结果显示,与丙戊酸剂量相关的纤维蛋白原减少的曲线下面积为0.766,敏感度为98.5%,特异度为54.3%,切点所示丙戊酸剂量为13.311 7 mg/kg。结论:患者使用丙戊酸剂量越大、年龄越小,发生纤维蛋白原减少的可能性越大,对于长期使用丙戊酸的患者即使使用正常剂量,也要注意定期监测纤维蛋白原变化,剂量大于13.311 7 mg/kg时,应增加纤维蛋白原监测频率。
OBJECTIVE： To investigate related factors for valproic acid-induced fibrinogenopenia in epilepsy patients.METHODS：A retrospective survey was conducted to collect the epilepsy patients treated with routine dose of valproic acid regularly more than one week in Epilepsy Diagnosis and Treatment Center of Xuanwu Hospital,Capital Medical University during Jan. 1 st,2017 to Mar. 1 st,2017. The general situation,drug use（dosage of valproic acid,dosage form of valproic acid,drug combination）,liver function,blood routine indexes and coagulation indexes,etc. were collected. Univariate and binary Logistic regression analysis were used to analyze the relationship of above factors with fibrinogenopenia. ROC curve was used to screen and predict the cut-off points when sensitivity and specificity of fibrinogenopenia were good. RESULTS：A total of 59 valid cases were collected,including 40 male（67.8%）and 19 female（32.2%）;35 patients（59.3%）were under 14 years of age,and 24 patients（40.7%）over 14 years of age,with average age of（17.2±15.7）. Of these,24 had fibrinogenopenia（40.7%）. Univariate analysis showed that fibrinogenopenia was negatively correlated with age（P=0.042）,but was positively correlated with dosage of valproic acid（P=0.003）;fibrinogenopenia was not correlated with gender（P=0.679）,dosage form of valproic acid（P=0.790）or drug combination（P=0.502）. Binary Logistic regression analysis showed that dosage of valproic acid and neutrophil percentage,erythrocyte count and platelet count of patients were related risk factors of fibrinogenopenia;odds ratios of related risk factors were1.101,0.925,0.132,0.976. ROC curve showed that the area under the ROC curve which was correlated with dosage of valproic acid was 0.766,sensitivity and specificity were 98.5% and 54.3%;the cut-off dosage was 13.311 7 mg/kg. CONCLUSIONS：The greater the dosage of valproic acid and the younger the age,the greater the possibility of the fibrinogenopenia. For patients with long-term use of valproic acid,even if the normal dosage are used,it is necessary to monitor fibrinogen changes regularly,for whom the dosage are greater than 13.311 7 mg/kg,the frequency of fibrinogen monitoring should be increased.
作者
齐晓涟
杨迦雯
QI Xiaolian;YANG Jiawen(Dept. of Pharmacy,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)
出处
《中国药房》
CAS
北大核心
2018年第11期1550-1554,共5页
China Pharmacy
关键词
癫痫患者
丙戊酸
纤维蛋白原减少
相关因素分析
Epilepsy patients；Valproic acid；Fibrinogen openia reduction；Analysis of related factor
