Riva R, Zaccara G, Albani F, Galli G, Campostrini R, Paganini M, Baruzzi A
Institute of Neurology, University of Bologna, Italy.
Epilepsy Res. 1991 Mar;8(2):149-52. doi: 10.1016/0920-1211(91)90083-r.
Serial plasma samples collected after an acute administration of valproic acid, (VPA, 15 mg/kg as oral solution) in epileptic patients were selected for this study. The plasma samples were selected from three different groups of patients; patients on phenobarbital and phenytoin with clinical VPA intolerance (group A); patients on phenobarbital and phenytoin without clinical VPA toxicity (group B); and patients without phenobarbital and phenytoin and without clinical VPA toxicity (group C). Plasma samples from 6 patients per group were analyzed for carnitines and ammonia. Ammonia levels during acute study increased significantly (P less than 0.05) in patients who experienced VPA intolerance, while no changes were found in the other patients. After acute VPA administration, total carnitine was unchanged but free carnitine was decreased (P less than 0.05) and carnitine esters were increased (P less than 0.05) in all groups of patients studied. No difference in carnitine profiles was seen between patients with or without evidence of VPA administration has an important effect on carnitine metabolism. However, unlike the acute effect on ammonia metabolism, this acute effect does not seem to be correlated with any associated antiepileptic therapy, nor does it predict clinical VPA intolerance.
本研究选取了癫痫患者在急性服用丙戊酸（VPA，口服溶液剂，15mg/kg）后采集的系列血浆样本。血浆样本来自三组不同的患者：服用苯巴比妥和苯妥英且临床上对VPA不耐受的患者（A组）；服用苯巴比妥和苯妥英但无临床VPA毒性的患者（B组）；未服用苯巴比妥和苯妥英且无临床VPA毒性的患者（C组）。对每组6例患者的血浆样本进行肉碱和氨分析。在急性研究期间，经历VPA不耐受的患者氨水平显著升高（P<0.05），而其他患者未发现变化。急性给予VPA后，所有研究患者组的总肉碱未变，但游离肉碱降低（P<0.05），肉碱酯增加（P<0.05）。在有或无VPA给药证据的患者之间，肉碱谱未见差异。VPA给药对肉碱代谢有重要影响。然而，与对氨代谢的急性影响不同，这种急性影响似乎与任何相关的抗癫痫治疗均无关联，也不能预测临床VPA不耐受。
