丙戊酸钠治疗小儿全面强直阵挛性发作相关认知功能障碍的影响因素分析

An analysis of factors influencing cognitive impairment after treatment of generalized tonic-clonic seizures in children with sodium valproate

摘要:

目的 探讨丙戊酸钠治疗全面强直阵挛性发作相关认知功能障碍的影响因素。方法 选取2017年1月至2019年5月在我院就诊的80例小儿全面强直阵挛性发作癫痫患者作为研究对象。所有患儿均给予丙戊酸钠治疗，后依据韦氏儿童智力量表（WlSC-CR）智商得分分为认知正常组（≥ 80分）和认知障碍组（<80分）。分析丙戊酸钠治疗3个月后认知功能障碍的影响因素。结果 两组患儿的发病年龄、每月发病频率、治疗剂量及疗程比较，差异有统计学意义（P<0.05）。回归分析显示，发病年龄<5岁、每月发病频率≥ 3次、治疗剂量≥ 35 mg/（kg·d）、治疗疗程≥ 6个月是丙戊酸钠治疗小儿癫痫后认知功能障碍的危险因素（P<0.05）。认知障碍组治疗3个月后每月发病频率、治疗剂量、治疗疗程与VIQ、PIQ、FIQ呈负相关（P<0.05）；发病年龄与VIQ、PIQ、FIQ呈正相关（P<0.05）。结论 发病年龄<5岁、每月发病频次≥ 3次、治疗剂量≥ 35 mg/（kg·d）、治疗疗程≥ 6个月是丙戊酸钠治疗小儿癫痫后认知功能障碍的危险因素。

Abstract:

Objective To explore the factors influencing cognitive impairment after treatment of generalized tonic-clonic seizures in children with sodium valproate.Methods Eighty children admitted to our hospital for generalized tonic-clonic seizures from January 2017 to May 2019 were enrolled as subjects. All the children were treated with sodium valproate. The patients were divided into normal group (≥ 80) and cognitive impairment group (<80) according to intelligence quotient (IQ) scores of the Wechsler Intelligence Scale for Children-China Revised. The influencing factors were analyzed for cognitive impairment after 3 months of treatment with sodium valproate.Results There were significant differences in age of onset, frequency of onset per month, therapeutic dose, and duration of treatment between the two groups (P<0.05). According to the results of regression analysis, onset before age 5 years, no less than 3 times of onset per month, a therapeutic dose of ≥ 35 mg/(kg·d), and no less than 6 months of treatment were risk factors for cognitive impairment after treatment of generalized tonic-clonic seizures in children with sodium valproate (P<0.05). In the cognitive impairment group treated with sodium valproate for 3 months, verbal IQ, performance IQ, and full-scale IQ scores were positively correlated with age of onset (P<0.05) but negatively correlated with frequency of onset per month, therapeutic dose, and duration of treatment (P<0.05).Conclusions Onset before age 5 years, no less than 3 times of onset per month, a therapeutic dose of ≥ 35 mg/(kg·d), and no less than 6 months of treatment are risk factors for cognitive impairment after treatment of generalized tonic-clonic seizures in children with sodium valproate.