[1]李秭瑶,刘 悦,王冬至,等.癫痫患儿丙戊酸治疗后血液氨基酸谱水平变化及临床意义[J].现代检验医学杂志,2017,32(05):24-27,31.[doi:10.3969/j.issn.1671-7414.2017.05.007]
　LI Zi-yao,LIU Yue,WANG Dong-zhi,et al.Clinical Significance of the Changes of Amino Acid in Children with Epilepsy on Valproate Monotherapy[J].Journal of Modern Laboratory Medicine,2017,32(05):24-27,31.[doi:10.3969/j.issn.1671-7414.2017.05.007]
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癫痫患儿丙戊酸治疗后血液氨基酸谱水平变化及临床意义()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第32卷
期数:
2017年05期
页码:
24-27,31
栏目:
论著
出版日期:
2017-11-02

文章信息/Info

Title:
Clinical Significance of the Changes of Amino Acid in Children with Epilepsy on Valproate Monotherapy
文章编号:
1671-7414(2017)05-024-05
作者:
李秭瑶1; 刘 悦1; 王冬至1; 曹 妍2; 李启亮2; 宋文琪2
1.首都医科大学医学检验技术学系,北京 100069; 2.国家儿童医学中心 首都医科大学附属北京儿童医院检验中心,北京 100045
Author(s):
LI Zi-yao1; LIU Yue1; WANG Dong-zhi1; CAO Yan2; LI Qi-liang2; SONG Wen-qi2
1.Department of Laboratory Medicine,Capital Medical University,Beijing 100069,China; 2.Department of Clinical Laboratory Center,Beijing Children's Hospital, Capital Medical University,National Center for Children's Health,Beijing 100045,China
关键词:
儿童;  癫痫;  丙戊酸;  氨基酸;  肝毒性
分类号:
R742.1; R446.112
DOI:
10.3969/j.issn.1671-7414.2017.05.007
文献标志码:
A
摘要:
目的 研究癫痫患儿经单独使用丙戊酸(VPA)治疗前后血液中氨基酸变化情况,进一步分析血液氨基酸变化的原因,以便进一步为临床监测VPA肝毒性提供实验室依据。方法 疾病组选自2015年6月～2017年2月在北京儿童医院进行VPA治疗监测的癫痫患儿178例,对照组选自同时期的年龄和性别匹配的表观健康儿童178例。收集研究对象的临床基线资料和肝肾功能指标结果。利用荧光偏振免疫法监测患儿VPA的血药浓度,使用液相色谱-串联质谱技术检测患儿血液中氨基酸的浓度。比较疾病组VPA治疗前后以及对照组之间氨基酸的水平差异。结果 与对照组比较,VPA治疗前、后患儿的尿素和肌酐水平的差异无统计学意义(F=0.187～0.970,P>0.05)。但肝酶谱的变化较大,与对照组和VPA治疗前相比,VPA治疗后癫痫患儿的ALT,AST和γ-GT水平显著增高(F=3.547～16.181,P<0.05)。与对照组和VPA治疗前相比,经VPA治疗后的癫痫患儿血液中Cys,Gln,Glu,Gly,Leu和Lys的差异有统计学意义(F=3.489～71.896,P<0.05),Cys,Gln,Glu,Gly和Lys明显升高,而Leu水平明显降低。结论 ALT,AST和γ-GT的升高预示着VPA或其代谢产物具有一定的致肝损伤的作用。在VPA肝毒性作用的早期,患儿血氨基酸水平已经发生了明显的变化,因此血氨基酸可能是反映VPA肝毒性比较敏感的指标。定期检查VPA治疗后患儿的血氨基酸谱的变化情况,可能对临床监测VPA导致的肝毒性具有一定意义。
Abstract:
Abstract:Objective To provide laboratory diagnosis for clinical monitoring of VPA hepatotoxicity,this study explored the levels of amino acid in children with epilepsy on valproate monotherapy.Methods The disease subjects were selected from 178 children with epilepsy treated by VPA only in Beijing Children's Hospital from June 2015 to February 2017,and the control subjects were selected from 178 healthy children with age-and sex-matched.The baseline clinical data and liver and renal function results were collected.The concentrations of VPA in children were monitored by fluorescence polarization immunoassay,the levels of amino acids in the blood dryspot were detected by liquid chromatography tandem mass spectrometry.The levelsof amino acids between the disease group before and after VPA therapy and the control group were compared.Results Compared with controls,there was no significant difference in the level of urea and creatinine between patients before and after VPA treatment(F=0.187～0.970,P>0.05).Compared with the control group and the patients before VPA treatment,the levels ofALT,AST and γ-GT of the patients after VPA treatment increased obviously(F=3.547～16.181,P<0.05).Compared with the control group and before VPA treatment,the levels of Cys,Gln,Glu,Gly,Leu and Lys(F=3.489～71.896,P<0.05)in the blood of children with epilepsy after VPA treatment were significantly different.The levels of Cys,Gln,Glu,Gly,VPA and Lys in the blood of the children with epilepsy treated by VPA were significantly higher than those inthe control group and before VPA treatment,but the level of Leu was lower thanthat of the control group and before treatment with VPA.ConclusionThe increases of ALT,AST and γ-GT indicated that VPA or its metabolites induced liver injury of patients.In the early stage of VPA hepatotoxicity,the levels of amino acid in children had changed obviously,so detection of amino acid may be a sensitive index to reflect the hepatotoxicity of VPA.Regular examination of amino acid in children after VPA treatment may be helpful for the clinical monitoring of hepatotoxicity caused by VPA.

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备注/Memo

备注/Memo:
作者简介:李秭瑶(1996-),女,在读本科生,研究方向:生化检验,E-mail:747960906@qq.com。 通讯作者:李启亮(1979-),女,副主任检验师,研究方向:小儿生化检验及分子诊断,E-mail:liqiliang2005@126.com。 宋文琪(1962-),女,主任检验师,研究方向:小儿生化检验及实验室管理,E-mail:Songwenqi1218@163.com。
更新日期/Last Update: 1900-01-01