在患者接受酸治疗时,出现高氨血的危险因素
Dong Won Kwack1, Dong Wook Kim1
1Department of Neurology, Konkuk University School of Medicine, Seoul, the Republic of Korea.
Clinical neurology and neurosurgery
|September 17, 2023
概括
抗发作药物 (ASM) 的较高总药物负载和托皮拉的使用是患者中酸 (VPA) 诱导的高氨血的关键风险因素. 早期识别对于管理这种罕见但严重的并发症至关重要.
科学领域:
- 神经学 神经学
- 临床药理学 临床药理学
- 药物监督 药物监督 药物监督
背景情况:
- 瓦尔酸 (VPA) 治疗可能导致高氨血症,这种罕见的并发症被称为VPA相关的高氨性脑病变 (VHE).
- VHE可以表现为严重的神经症状,包括失去意识和增加发作频率.
- 鉴定VPA诱导的高氨血的危险因素对于患者的安全至关重要.
研究的目的:
- 调查和确定与治疗酸 (VPA) 的成年患者的高氨血症发展相关的特定风险因素.
主要方法:
- 对116名成年患者进行了回顾性审查,他们在三年内接受了VPA治疗,分析了血液氨水平与VPA剂量和血液水平的对比.
- 利用单变量和多变量线性回归分析来确定超氨血的独立预测因素,将其定义为氨水平>80μg/dL.
主要成果:
- 血氨水平与VPA剂量相关 (p=0.036) 但不与VPA血水平相关 (p=0.463).
- 较高的VPA剂量,同时服用抗发作药物 (ASM) 的总药物负载增加,以及托皮拉或芬诺巴比塔尔的使用与超血症有关.
- 多变量分析确定了ASM总药物负载 (p=0.003) 和托皮拉玛使用 (p=0.007) 作为独立预测因素. 在3.4%的患者中观察到VHE症状.
结论:
- 增加的ASM总负载和托皮拉马特的使用是VPA的患者中高氨血的显著独立风险因素.
- 虽然VHE发病率很低 (3.4%),但临床医生必须保持对高氨血的警,特别是在接受ASM多疗的患者中,包括托皮拉.
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