Sharma Tarun Kumar, Vardey S K, Sitaraman S
Clin Lab. 2015;61(8):933-40. doi: 10.7754/clin.lab.2015.141230.
The data regarding Valproate and its influence on serum folate and homocysteine levels are conflicting. The aim of this study was to evaluate whether differences exist in homocysteine, folate, and vitamin B12 levels in children receiving Valproate.
A total of 55 newly diagnosed epileptic children with ages ranging from 2 to 15 years were enrolled at the start of study but after 3 months follow up, the total sample size finally was only 50 epileptic children. 5 children dropped out of study due to poor follow up. 50 age and gender matched healthy control subjects were also studied on enrollment at the start of study. Serum homocysteine levels were analyzed by enzyme immunoassay method using the kits provided by Axis-Shield Diagnostics Ltd (Dundee DD2 1XA, United Kingdom). Serum folate and serum vitamin B12 were estimated by Competitive Chemiluminescent Enzyme Immunoassay method.
The serum homocysteine level in epileptic children was found to be significantly increased after Valproate monotherapy as compared to before therapy. Moreover, a highly significant decrease was observed in the levels of serum folate in epileptic children after Valproate monotherapy as compared to before therapy. But a non significant difference was observed in serum vitamin B12 levels in epileptic children before and after Valproate monotherapy.
Thus, we conclude that there is a significant increase in the levels of homocysteine and a significant decrease in the concentration of serum folate while vitamin B12 decreases non-significantly after Valproate monotherapy. The atherogenic effect of increased serum homocysteine level is well established; the patients under Valproate monotherapy should be monitored for possible atherogenic effects. Considering the above observation and results of children undergoing Valproate monotherapy, these children should be screened for levels of serum homocysteine, folate, and vitamin B12 and treated when their levels are found to be disturbed.
关于丙戊酸盐及其对血清叶酸和同型半胱氨酸水平影响的数据相互矛盾。本研究的目的是评估接受丙戊酸盐治疗的儿童在同型半胱氨酸、叶酸和维生素B12水平上是否存在差异。
共纳入55名新诊断的2至15岁癫痫儿童，研究开始时入组，但3个月随访后，最终样本量仅为50名癫痫儿童。5名儿童因随访不佳退出研究。还在研究开始时入组了50名年龄和性别匹配的健康对照者。采用Axis-Shield Diagnostics Ltd（英国邓迪DD2 1XA）提供的试剂盒，通过酶免疫分析法分析血清同型半胱氨酸水平。采用竞争性化学发光酶免疫分析法测定血清叶酸和血清维生素B12。
与治疗前相比，癫痫儿童在丙戊酸盐单药治疗后血清同型半胱氨酸水平显著升高。此外，与治疗前相比，癫痫儿童在丙戊酸盐单药治疗后血清叶酸水平显著降低。但癫痫儿童在丙戊酸盐单药治疗前后血清维生素B12水平无显著差异。
因此，我们得出结论，丙戊酸盐单药治疗后同型半胱氨酸水平显著升高，血清叶酸浓度显著降低，而维生素B12水平无显著降低。血清同型半胱氨酸水平升高的致动脉粥样硬化作用已得到充分证实；应监测接受丙戊酸盐单药治疗的患者是否可能出现致动脉粥样硬化作用。考虑到上述观察结果以及接受丙戊酸盐单药治疗儿童的结果，应对这些儿童进行血清同型半胱氨酸、叶酸和维生素B12水平筛查，当其水平出现紊乱时进行治疗。
