新型抗癫痫药物对儿童骨代谢和骨密度的影响：一项荟萃分析。
Effects of new antiseizure medication on bone metabolism and bone mineral density in children: A meta-analysis.
作者信息
Zhuo La, Zhang Yong
机构信息
Department of Pharmacy, Maternal and Child Health Hospital of Inner Mongolia Autonomous Region, Hohhot City, China.
Department of Clinical Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China.
出版信息
Front Pediatr. 2022 Nov 15;10:1015691. doi: 10.3389/fped.2022.1015691. eCollection 2022.
OBJECTIVE
To explore the effect of new antiseizure medication on bone metabolism and bone mineral density in children
METHODS
The Chinese and English databases (PubMed, EMBASE, Cochrane Library, CNKI, Wanfang and VIP) were systematically searched for observational studies evaluating the effects of new antiseizure medication on bone metabolism and bone mineral density in children with epilepsy. The effects of new antiseizure medication on serum calcium, phosphorus, alkaline phosphatase, bone alkaline phosphatase, parathyroid hormone, 25-hydroxyvitamin D and bone mineral density in children were systematically evaluated.
RESULTS
After systematic retrieval and screening, 12 studies with high literature quality (including 629 epileptic children and 627 control subjects) were included in the systematic evaluation. Meta-analysis showed that new antiseizure medication decreased bone mineral density (MD: -0.05, 95%CI, -0.09, -0.02; = 0.004). From different kinds of antiseizure medication, levetiracetam can reduce blood phosphorus concentration in children (MD: -0.04; 95%CI, -0.07, -0.01). Oxcarbazepine increased serum alkaline phosphatase in children (MD:17.98; 95%CI, 10.43,25.53; < 0.00001), and the increase intensity was significantly higher than that of levetiracetam (MD: 7.66; 95%CI, 0.29, 15.02; = 0.04). In addition, oxcarbazepine can cause a significant increase in parathyroid hormone in children (MD: 7.52; 95%CI, 3.37,11.66; = 0.0004), and 25 - hydroxyvitamin D was reduced, and the difference was statistically significant (MD:-2.18; 95%CI, -3.23, -1.13; = 0.00006). However, the effects of new antiseizure medication on serum calcium and bone alkaline phosphatase in children were not statistically significant.
CONCLUSION
New antiseizure medication have different effects on bone metabolism and bone mineral density in children with epilepsy, and the effects of different types of new antiseizure medication are different.
目的
探讨新型抗癫痫药物对儿童骨代谢及骨密度的影响。
方法
系统检索中英文数据库（PubMed、EMBASE、Cochrane图书馆、中国知网、万方和维普），查找评估新型抗癫痫药物对癫痫患儿骨代谢及骨密度影响的观察性研究。系统评价新型抗癫痫药物对儿童血清钙、磷、碱性磷酸酶、骨碱性磷酸酶、甲状旁腺激素、25-羟维生素D及骨密度的影响。
结果
经过系统检索和筛选，12项文献质量较高的研究（包括629例癫痫患儿和627例对照）纳入系统评价。Meta分析显示，新型抗癫痫药物可降低骨密度（MD：-0.05，95%CI，-0.09，-0.02；P = 0.004）。不同种类的抗癫痫药物中，左乙拉西坦可降低儿童血磷浓度（MD：-0.04；95%CI，-0.07，-0.01）。奥卡西平可使儿童血清碱性磷酸酶升高（MD：17.98；95%CI，10.43，25.53；P < 0.00001），升高强度显著高于左乙拉西坦（MD：7.66；95%CI，0.29，15.02；P = 0.04）。此外，奥卡西平可使儿童甲状旁腺激素显著升高（MD：7.52；95%CI，3.37，11.66；P = 0.0004），25-羟维生素D降低，差异有统计学意义（MD：-2.18；95%CI，-3.23，-1.13；P = 0.00006）。然而，新型抗癫痫药物对儿童血清钙和骨碱性磷酸酶的影响无统计学意义。
结论
新型抗癫痫药物对癫痫患儿骨代谢及骨密度有不同影响，不同类型的新型抗癫痫药物作用不同。
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