【摘要】 背景癫痫患者需长期或大剂量服用抗癫痫药物(AEDs)来控制病情,既往临床多关注AEDs所致的肝肾功能损伤,忽视了其对生殖功能的影响。目前关于AEDs对癫痫患者生殖功能的影响尚存在争议。目的比较奥卡西平、拉莫三嗪、左乙拉西坦、托吡酯对新诊断青年男性癫痫患者性激素及性功能的影响。方法回顾性选取2016—2019年钦州市第二人民医院神经内科收治的新诊断青年男性癫痫患者200例,基于其癫痫发作类型随机给予新型AEDs治疗,将其中服用奥卡西平者分为A组,服用拉莫三嗪者分为B组,服用左乙拉西坦者分为C组,服用托吡酯者分为D组,各50例。比较四组患者治疗前及治疗后6、12个月催乳素(PRL)、卵泡刺激素(FSH)、促黄体生成素(LH)、睾酮(T)、雌二醇(E2)水平、国际勃起功能指数5(IIEF-5)评分、早泄诊断工具(PEDT)评分。结果最终A组纳入42例,B组纳入43例,C组纳入46例,D组纳入40例。时间与治疗方法在LH水平上存在交互作用(P <0.05),在PRL、FSH、T、E2水平上无交互作用(P>0.05);治疗方法在PRL、FSH、LH、T水平上主效应显著(P <0.05),在E2水平上主效应不显著(P>0.05);时间在PRL、FSH、LH水平上主效应显著(P <0.05),在T、E2水平上主效应不显著(P>0.05)。A组患者治疗后6、12个月FSH水平及治疗后12个月LH、T水平分别高于本组治疗前,治疗后12个月FSH水平高于本组治疗后6个月(P <0.05);C组患者治疗后6、12个月T水平分别高于本组治疗前,治疗后12个月T水平高于本组治疗后6个月(P <0.05);D组患者治疗后6、12个月PRL水平分别低于本组治疗前,LH水平分别高于本组治疗前(P <0.05);D组患者治疗后12个月PRL水平低于本组治疗后6个月,LH水平高于本组治疗后6个月(P <0.05)。B、C、D组患者治疗后12个月FSH水平低于A组(P <0.05);C组患者治疗后12个月T水平高于B组;D组患者治疗后6、12个月PRL水平低于A、B、C组,LH水平高于A、B、C组(P <0.05);D组患者治疗后12个月T水平低于A、C组(P <0.05)。时间与治疗方法在IIEF-5评分、PEDT评分上存在交互作用(P <0.05);治疗方法、时间在IIEF-5评分、PEDT评分上主效应均显著(P <0.05)。A、B组患者治疗后6、12个月IIEF-5评分分别高于本组治疗前,PEDT评分分别低于本组治疗前(P <0.05);D组患者治疗后6、12个月IIEF-5评分分别低于本组治疗前,PEDT评分分别高于本组治疗前(P <0.05);A、B组患者治疗后12个月IIEF-5评分分别高于本组治疗后6个月,PEDT评分分别低于本组治疗治疗后6个月(P <0.05);D组患者治疗后12个月IIEF-5评分低于本组治疗后6个月,PEDT评分高于本组治疗后6个月(P <0.05)。B、C、D组患者治疗后6、12个月IIEF-5评分低于A组,PEDT评分高于A组(P <0.05);C、D组患者治疗后6、12个月IIEF-5评分低于B组,PEDT评分高于B组(P <0.05);D组患者治疗后6、12个月IIEF-5评分低于C组,PEDT评分高于C组(P <0.05)。结论针对新诊断青年男性癫痫患者,奥卡西平可升高其FSH、LH、T水平,进而改善性功能;拉莫三嗪对其性激素可能无影响,但对性功能有一定改善作用;左乙拉西坦可升高其T水平,但对性功能可能无影响;托吡酯可降低其PRL水平,升高LH水平,可能会引起性功能下降或性功能障碍。因此,建议有生育需求的青年男性癫痫患者优先考虑采用奥卡西平治疗。更多还原

【Abstract】 Background Patients with epilepsy need long-term or high-dose antiepileptic drugs(AEDs) to control their condition.In the past,more attention were paid to the damage of liver and kidney function caused by AEDs,while the impact of AEDs on reproductive function was ignored.At present,the impact of AEDs on reproductive function of epileptic patients is still controversial.Objective To compare the impact of Oxcarbazepine,Lamotrigine,Levetiracetam and Topiramate on sex hormones and sexual function in young male patients with newly diagnosed epilepsy.Methods Two hundred young male patients with newly diagnosed epilepsy in the Department of Neurology,the Second People’s Hospital of Qinzhou from 2016 to 2019 were enrolled in this study.According to the novel AEDs used,all patients were randomly divided into four groups(group A: Oxcarbazepine,group B: Lamotrigine,group C: Levetiracetam,group D:Topiramate),with 50 cases in each group. Levels of prolactin(PRL),follicle stimulating hormone(FSH),luteinizing hormone(LH),testosterone(T),estradiol(E2),and scores of International Index of Erectile Function-5(IIEF-5) and Premature Ejaculation Diagnosis Tools(PEDT) in the four groups before treatment,6 months and 12 months after treatment were compared.Results Forty-two cases in group A,43 cases in group B,46 cases in group C and 40 cases in group D were included in the final analysis. There was an interaction between time and treatment options on the level of LH(P <0.05),but no interaction existed between time and treatment options on levels of PRL,FSH,T,E2(P >0.05).The main effect of treatment options was significant on levels of PRL,FSH,LH,T(P <0.05),but not significant on the level of E2(P >0.05).The main effect of time was significant on levels of PRL,FSH,LH(P <0.05),but not significant on levels of T,E2(P >0.05).In the group A,FSH level at 6,12 months after treatment,LH and T level at 12 months after treatment were respectively higher than those before treatment(P <0.05);FSH level at 12 months after treatment was higher than that at 6 months after treatment(P <0.05).In the group C,T level at 6,12 months after treatment was respectively higher than that before treatment,and T level at 12 months after treatment was higher than that at 6 months after treatment(P <0.05).In the group D,PRL level at 6,12 months after treatment was respectively lower than that before treatment,but LH level at 6,12 months after treatment was higher than that before treatment(P <0.05);in the group D,PRL level at 12 months after treatment was lower than that at 6 months after treatment,but LH level at 12 months after treatment was higher than that at 6 months after treatment(P <0.05).FSH level in the groups B,C,D was lower than that in the group A(P <0.05);T level at 12 months after treatment in the group C was higher than that in the group B(P <0.05);PRL level at 6,12 months after treatment of group D was lower than that in the groups A,B,C,but LH level at 6,12 months after treatment was higher than that in the groups A,B,C(P <0.05);T level at 12 months after treatment in the group D was lower than that in the groups A,C(P <0.05).There was an interaction between time and treatment options on scores of IIEF-5,PEDT(P <0.05).The main effect of treatment options and time were significant on scores of IIEF-5,PEDT(P <0.05).IIEF-5 score at 6,12 months after treatment of groups A,B was respectively higher than that before treatment,PEDT score was respectively lower than that before treatment(P <0.05);IIEF-5 score at 6,12 months after treatment of group D was respectively lower than that before treatment,PEDT score was higher than that before treatment(P <0.05);IIEF-5 score at 12 months after treatment of groups A,B was respectively higher than that 6 months after treatment,PEDT score was lower than that 6 months after treatment(P <0.05);IIEF-5 score at 12 months after treatment of group D was respectively lower than that 6 months after treatment,PEDT score was higher than that 6 months after treatment(P <0.05).IIEF-5 score at 6,12 months after treatment of groups B,C,D was lower than that of group A,PEDT score was higher than that of group A(P <0.05).IIEF-5 score at 6,12 months after treatment of groups C,D was lower than that of group B,PEDT score was higher than that of group B(P <0.05).IIEF-5 score at 6,12 months after treatment of group D was lower than that of group C,PEDT score was higher than that of group C(P <0.05).Conclusion As for young male patients with newly diagnosed epilepsy,Oxcarbazepine can increase levels of FSH,LH and T,as well as improve sexual function;Lamotrigine may have no effect on sex hormones,but it can improve sexual function;Levetiracetam can increase the level of T,while it may have no effect on the sexual function;Topiramate can reduce the level of PRL,and increase the level of LH,which may cause decreased sexual function or sexual dysfunction.Therefore,it is recommended that the young male patients with epilepsy who have childbearing needs should give priority to the the treatment with Oxcarbazepine.更多还原