Mikkonen Kirsi, Tapanainen Päivi, Pakarinen Arto J, Päivänsalo Markku, Isojärvi Jouko I T, Vainionpää Leena K
Department of Pediatrics, University of Oulu, Finland.
Epilepsia. 2004 Jul;45(7):769-76. doi: 10.1111/j.0013-9580.2004.04604.x.
To evaluate reproductive endocrine function in boys and young men with epilepsy taking an antiepileptic drug in a population-based, controlled study.
Seventy patients and 70 controls matched for age and pubertal stage participated in this study. Twenty-eight patients were taking carbamazepine (CBZ); five, lamotrigine (LTG); 12, oxcarbazepine (OXC); and 25, valproate (VPA) as monotherapy for epilepsy. All subjects were examined clinically, and their medical histories were obtained. Serum reproductive hormone and sex hormone-binding globulin concentrations were measured, and testicular ultrasonography was performed.
Serum testosterone levels were within the normal range in young male patients with epilepsy. However, the patients taking VPA had high serum androstenedione levels at all pubertal stages. In prepuberty, their serum androstenedione values were already approximately fivefold compared with the values of the controls (8.7 nM; SD, 4.0 vs. 1.8 nM, SD, 1.0; p < 0.0003), and they were elevated in 64% of the VPA-treated patients compared with none of the other patients, p = 0.0006. Serum sex hormone-binding globulin levels were increased, and serum dehydroepiandrosterone sulfate concentrations decreased in the pubertal patients taking CBZ. The mean testicular volumes did not differ between the patients and the controls.
CBZ and VPA, but not LTG and OXC, are associated with changes in serum sex-hormone levels in boys and young men with epilepsy. However, the long-term health consequences of these reproductive endocrine changes during pubertal development remain to be established.
在一项基于人群的对照研究中，评估服用抗癫痫药物的癫痫男孩和青年男性的生殖内分泌功能。
70例患者和70例年龄及青春期阶段相匹配的对照者参与了本研究。28例患者服用卡马西平（CBZ）；5例服用拉莫三嗪（LTG）；12例服用奥卡西平（OXC）；25例服用丙戊酸盐（VPA）作为癫痫的单一疗法。所有受试者均接受临床检查并获取其病史。检测血清生殖激素和性激素结合球蛋白浓度，并进行睾丸超声检查。
癫痫青年男性患者的血清睾酮水平在正常范围内。然而，服用VPA的患者在所有青春期阶段血清雄烯二酮水平均较高。在青春期前，他们的血清雄烯二酮值与对照组相比已高出约五倍（8.7 nM；标准差4.0 vs. 1.8 nM，标准差1.0；p < 0.0003），并且与其他患者无一例升高相比，64%接受VPA治疗的患者升高，p = 0.0006。服用CBZ的青春期患者血清性激素结合球蛋白水平升高，血清硫酸脱氢表雄酮浓度降低。患者与对照组的平均睾丸体积无差异。
CBZ和VPA，但不包括LTG和OXC，与癫痫男孩和青年男性的血清性激素水平变化有关。然而，这些青春期发育过程中生殖内分泌变化的长期健康后果仍有待确定。
