Department of Pediatric Neurology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Division of Neonatology, Department of Child Health and Diseases, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
Pediatr Int. 2021 Nov;63(11):1351-1356. doi: 10.1111/ped.14674. Epub 2021 Oct 18.
Weight gain is an important adverse effect of valproate (VPA) therapy. A number of mechanisms have been proposed for its pathophysiology. The aim of the present study is the evaluation of insulin, leptin and lipid levels in epileptic children on treatment with VPA.
Thirty epileptic children treated with VPA, and 20 age-sex-matched healthy children, were enrolled in this study. Blood samples were taken and the body mass index was calculated for all of the subjects. Serum insulin, leptin, and lipid levels were compared between the two groups.
Leptin levels were significantly higher in the patient group (P = 0.009) whereas body mass index values were comparable. There was a positive correlation between leptin and body mass index among both patient (r = 0.464, P = 0.01) and control groups (r = 0.734, P = 0.0001). Total cholesterol and low-density lipoprotein (LDL) cholesterol levels were lower in VPA-treated epileptic children than the control group (P = 0.008; P = 0.003, respectively). No significant difference was determined in insulin levels between the two groups. A negative correlation was observed between plasma VPA level and total cholesterol and LDL cholesterol levels in the patient group (r = -0.380, P = 0.03, r = -0.474, P = 0.008, respectively).
This study demonstrated higher leptin levels in the patient group despite similar BMI values. Hence, it seems likely that VPA causes leptin resistance. Unlike other anti-epileptics, VPA does not produce an increase in serum cholesterol levels. On the contrary, lower levels of total and LDL cholesterol levels in VPA-receiving patients have been observed in our study.
体重增加是丙戊酸（VPA）治疗的一个重要不良反应。已经提出了许多机制来解释其病理生理学。本研究的目的是评估接受 VPA 治疗的癫痫儿童的胰岛素、瘦素和血脂水平。
本研究纳入了 30 名接受 VPA 治疗的癫痫儿童和 20 名年龄、性别匹配的健康儿童。对所有受试者采集血样并计算体重指数。比较两组的血清胰岛素、瘦素和血脂水平。
患者组的瘦素水平显著升高（P = 0.009），而体重指数值相当。在患者组（r = 0.464，P = 0.01）和对照组（r = 0.734，P = 0.0001）中，瘦素与体重指数之间均存在正相关。VPA 治疗的癫痫儿童的总胆固醇和低密度脂蛋白（LDL）胆固醇水平低于对照组（P = 0.008；P = 0.003）。两组间胰岛素水平无显著差异。在患者组中观察到血浆 VPA 水平与总胆固醇和 LDL 胆固醇水平呈负相关（r = -0.380，P = 0.03；r = -0.474，P = 0.008）。
尽管两组的 BMI 值相似，但本研究显示患者组的瘦素水平更高。因此，VPA 可能导致瘦素抵抗。与其他抗癫痫药不同，VPA 不会导致血清胆固醇水平升高。相反，在我们的研究中观察到接受 VPA 治疗的患者的总胆固醇和 LDL 胆固醇水平较低。
