内科

目的探讨拉考沙胺联合丙戊酸钠治疗癫痫患儿的临床疗效，分析其对神经损伤、脑电图相关指标的影响。方法将97例癫痫患儿随机分为单一组（n=48）和联合组（n=49）。单一组予以丙戊酸钠治疗，联合组在单一组的基础上加用拉考沙胺治疗，两组均治疗2个月。比较两组的临床疗效，治疗前和治疗2个月后的神经功能缺损程度和认知功能、脑电图参数、血清脑损伤指标、血清微小RNA（miRNA）水平，以及治疗期间两组不良反应的发生情况。结果治疗2个月后，联合组总有效率高于单一组；两组中国脑卒中患者临床神经功能缺损程度评分量表评分，每分钟棘波数，血清胰岛素样生长因子-1、神经元特异性烯醇化酶、中枢神经特异性蛋白β、胶质纤维酸性蛋白水平，以及血清miRNA-106b、miRNA-146a相对表达水平均低/少于治疗前，且联合组均低/少于单一组；两组简易精神状态检查量表评分均高于治疗前，且联合组高于单一组（均P<0.05）；两组α波、θ波、δ波活动率差异均无统计学意义（均P>0.05）。治疗期间，两组不良反应总发生率差异无统计学意义（P>0.05）。结论拉考沙胺联合丙戊酸钠治疗癫痫患儿的效果优于单用丙戊酸钠，可减轻神经损伤，改善认知功能和癫痫样放电，其机制可能与调低miRNA-106b、miRNA-146a表达有关。

【Abstract】 Objective To investigate the clinical efficacy of lacosamide combined with sodium valproate in the treatment of children with epilepsy, and to analyze its effects on neurological injury and electroencephalogram (EEG)-related indexes. Methods A total of 97 children with epilepsy were randomly divided into a single group (n=48) or a combined group (n=49). The single group was treated with sodium valproate, based on which the combined group was treated with lacosamide, and both groups were treated for 2 months. The clinical efficacy; neurological deficit, cognitive function, EEG parameters, serum brain injury indexes, and serum microRNAs (miRNAs) levels before treatment and after 2 months of treatment; and the occurrence of adverse reactions during the treatment were compared between the two groups. Results After 2 months of treatment, the total effective rate of the combined group was higher than that of the single group; the China Stroke Scale score, number of spike waves per minute, and serum levels of insulin-like growth factor-1, neuron-specific enolase, central nervous system specific protein β, and glial fibrillary acidic protein, as well as serum relative expression levels of miRNA-106b and miRNA-146a in the two groups were lower/less than those before treatment, and those in the combined group were lower/less than those in the single group; the scores of the Mini-Mental State Examination in the two groups were higher than those before treatment, and the score in the combined group was higher than that in the single group (all P<0.05); and there was no statistically significant difference in the activity rate of α, θ, or δ wave between the two groups (all P>0.05). No statistically significant difference in the total incidence of adverse reactions was observed between the two groups during treatment (P>0.05). Conclusion In the treatment of children with epilepsy, lacosamide in combination with sodium valproate has a better effect than sodium valproate alone, which can reduce neurological injury, improve cognitive function and epileptic discharge, and the mechanism may be related to the downregulated-expression of miRNA-106b and miRNA-146a.