王凌云+侯静+张勇

【摘要】 目的 探讨左乙拉西坦（LEV）联合拉莫三嗪（LTG）在老年性癫痫患者中的临床效果及对认知水平的影响。方法 92例年龄≥65岁的老年性癫痫患者， 根据随机数字法分为对照组和观察组， 每组46例。观察组采用LEV联合LTG治疗， 对照组采用LTG单药治疗， 两组疗程均为6个月， 比较两组临床效果， 并通过简易精神状态检查表（MMSE）评估两组治疗前及治疗6个月后的认知功能水平， 比较两组不良反应发生情况。结果 观察组总有效率97.83%优于对照组的86.96%， 差异具有统计学意义（P<0.05）。治疗6个月后两组MMSE评分与治疗前比较差异均无统计学意义（P>0.05）， 治疗6个月后观察组MMSE评分与对照组比较差异无统计学意义（P>0.05）。观察组治疗6个月后不良反应发生率为17.39%， 对照组治疗6个月后不良反应发生率为10.87%， 组间比较差异无统计学意义（P>0.05）。

结论 LEV联合LTG用于老年性癫痫患者中效果理想， 有助于提高临床疗效， 对患者认知水平无明显影响， 同时未增加药物不良反应， 适于临床应用。

【关键词】 左乙拉西坦；拉莫三嗪；老年性癫痫；认知功能

DOI：10.14163/j.cnki.11-5547/r.2018.05.002

【Abstract】 Objective To discuss the clinical effect of levetiracetam （LEV） combined with lamotrigine （LTG） in the treatment of elderly patients with epilepsy， and its influence on cognitive function. Methods A total of 92 elderly patients with epilepsy aged 65 or older were divided by random number method into control group and observation group， with 46 cases in each group. The observation group was treated with LEV and LTG， and the control group was treated with LTG only. Both groups were treated for 6 months， the clinical effects of the two groups were compared， and the cognitive function of the two groups before and after of 6 months treatment was evaluated by the mini mental state examination （MMSE）. The occurrence of adverse reactions in two groups was compared. Results The observation group had better total effective rate （97.83%） than the control group （86.96%）， and the difference was statistically significant （P<0.05）. After 6 months of treatment， both groups had no statistically significant difference in MMSE score than before treatment （P>0.05）. After 6 months of treatment， the observation group had no statistically significant difference in MMSE score comparing with the control group （P>0.05）. The observation group had no statistically significant difference in incidence of adverse reactions as 17.39% after 6 months of treatment， comparing with 10.87% in the control group （P>0.05）.

Conclusion Combination of LEV and LTG provides ideal effect， and helps improve clinical efficacy without obvious effect on cognitive level of patients. It does not increase the adverse drug reactions， and is suitable for clinical application.

【Key words】 Levetiracetam； Lamotrigine； Elderly epilepsy； Cognitive function

老年性癲痫是临床上常见的疾病， 指≥65岁发病的癫痫类型， 多数患者是由脑血管疾病引起， 具有发病率高、病情变化快、呈渐进性的特点， 且随着发病次数的不断增加， 将会造成患者自主生活能力丧失， 严重者甚至丧失对外界事物的判断能力。目前， 临床上对于老年性癫痫尚缺乏理想的治疗方法， 2011年抗癫痫药物应用专家共识中指出[1]， 拉莫三嗪（Lamotrigine， LTG）及左乙拉西坦（Levetiracetam， LEV）均可做为治疗老年性癫痫的主要药物。实际临床中， 临床医生发现将LEV联合LTG应用于老年性癫痫患者的治疗， 有助于提高临床效果。但有研究……