抗癫痫药物对癫痫男性性功能和生殖激素的差异影响：拉莫三嗪与酶诱导抗癫痫药物比较的中期分析

Differential effects of antiepileptic drugs on sexual function and reproductive hormones in men with epilepsy: interim analysis of a comparison between lamotrigine and enzyme-inducing antiepileptic drugs.

作者信息

Herzog Andrew G, Drislane Frank W, Schomer Donald L, Pennell Page B, Bromfield Edward B, Kelly Kevin M, Farina Erin L, Frye Cheryl A

机构信息

Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.

出版信息

Epilepsia. 2004 Jul;45(7):764-8. doi: 10.1111/j.0013-9580.2004.60703.x.

DOI:10.1111/j.0013-9580.2004.60703.x

PMID:15230699

Abstract

PURPOSE

We compared sexual function and reproductive hormone levels among men with localization-related epilepsy (LRE) taking various antiepileptic drugs (AEDs) and normal controls (NC).

METHODS

Subjects were 63 men with LRE [enzyme-inducing (EI) AEDs, 36; lamotrigine (LTG), 18; no AEDs, 9] and 18 NC. Sexual interest and function (S-score), hormone levels [bioactive testosterone (BAT) and estradiol (BAE)], hormone ratios [BAT/BAE], and gonadal efficiency [BAT/luteinizing hormone (LH)] were compared among the groups.

RESULTS

S-scores, BAT levels, BAT/BAE, and BAT/LH were significantly lower in the EIAED group than in NC or LTG groups. Sex hormone-binding globulin (SHBG) was significantly higher in the EIAED group than in all other groups. Of men with LRE, 23.8% had abnormally low S-scores: 33.3% taking EIAEDs, 5.5% taking LTG, and 22.2% taking no AEDs (p < 0.01). BAT was low in 55.6% taking EIAEDs as compared with 33.3% taking LTG and 33.3% taking no AEDs (p < 0.05). Among men with low S-scores, 86.7% had low BAT as compared with 33.3% of men with normal scores (p < 0.01). BAT decline with age was greater among men with LRE than in controls (3.75 vs. 1.80 ng/dl/yr). The slope showed no significant difference among LRE groups. However, 89% of 40- to 50-year-old men taking EIAEDs had low BAT as compared with 33% taking LTG and 33% taking no AED (p < 0.01).

CONCLUSIONS

Sexual function, BAT levels, BAT/BAE, and gonadal efficiency are greater with LTG than with EIAED. Abnormally low BAT levels are reached at an earlier age with EIAEDs than with LTG.

摘要

目的

我们比较了服用各种抗癫痫药物（AEDs）的局限性癫痫（LRE）男性患者与正常对照（NC）之间的性功能和生殖激素水平。

方法

研究对象为63例LRE男性患者[酶诱导（EI）AEDs组36例；拉莫三嗪（LTG）组18例；未服用AEDs组9例]和18例NC。比较了各组之间的性兴趣和功能（S评分）、激素水平[生物活性睾酮（BAT）和雌二醇（BAE）]、激素比值[BAT/BAE]以及性腺效率[BAT/促黄体生成素（LH）]。

结果

EI AEDs组的S评分、BAT水平、BAT/BAE和BAT/LH显著低于NC组或LTG组。EI AEDs组的性激素结合球蛋白（SHBG）显著高于所有其他组。LRE男性患者中，23.8%的患者S评分异常低：服用EI AEDs的患者中为33.3%，服用LTG的患者中为5.5%，未服用AEDs的患者中为22.2%（p<0.01）。服用EI AEDs的患者中有55.6%的BAT水平低，而服用LTG的患者中为33.3%，未服用AEDs的患者中为33.3%（p<0.05）。S评分低的男性患者中，86.7%的患者BAT水平低，而S评分正常的男性患者中这一比例为33.3%（p<0.01）。LRE男性患者中BAT随年龄下降的幅度大于对照组（3.75 ng/dl/年对1.80 ng/dl/年）。LRE各组之间斜率无显著差异。然而，40至50岁服用EI AEDs的男性患者中89%的BAT水平低，而服用LTG的患者中为33%，未服用AED的患者中为33%（p<0.01）。