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左卡尼汀用于使用丙戊酸的癫痫儿童有效性和安全性的系统评价 被引量:1

Efficacy and safety of carnitine for epileptic children using valproic acid:An evidence-based evaluation
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摘要 目的评价左卡尼汀用于使用丙戊酸的癫痫儿童的有效性及安全性。方法计算机检索Pub Med、Cochrane Library、Embase、CBM、CNKI、Wanfang Data和VIP,查找使用丙戊酸(valproic acid,VPA)的癫痫儿童使用左卡尼汀有效性和安全性的原始研究,检索时限均从建库至2017年3月。两位研究者独立筛选文献、资料提取及质量评价后,采用Rev Man 5.3软件进行Meta分析。结果最终纳入队列研究1项、前-后对照研究4项、病例报告6项,共206例患者。纳入研究质量均为偏倚高风险。Meta分析结果显示:(1)左卡尼汀用于VPA过量中毒的癫痫患儿可降低体内丙氨酸转氨酶(ALT)浓度[MD=-63.97,95%CI(-64.98,-62.96),P〈0.00001]和天冬氨酸转氨酶(AST)浓度[MD=-55.14,95%CI(-56.52,-53.76),P〈0.00001];(2)左卡尼汀用于有VPA肝毒性高危因素的癫痫患儿,可降低体内ALT浓度[MD=-12.53,95%CI(-15.32,-9.75),P〈0.00001]和AST浓度[MD=-19.45,95%CI(-36.50,-2.40),P=0.03]。结论现有证据表明,左卡尼汀用于使用丙戊酸的癫痫儿童可改善ALT、AST等肝功能指标,可提高体内左卡尼汀浓度、降低血氨浓度和提高患者生存质量。但受纳入研究数量和质量限制,上述结论尚需更多高质量研究证实。 Objective To systematically review the effectiveness and safety of carnitine for patients with epilepsy using valproic acid(VPA). Methods The clinical trials about carnitine for patients with epilepsy using VPA were searched in Pub Med,Cochrane Library,EMbase,CBM,CNKI,Wanfang Data and VIP from the date of their establishment to March 2017.Literature screening and methodological quality assessment were completed by two reviewers independently.Meta-analysis was conducted using Rev Man 5.3 software. Results A total of ten trials involving 206 patients were finally enrolled. The results of meta-analysis indicated that:(1)the carnitine for epileptic children who were intoxicated with VPA could decrease concentration of ALT and AST[ALT:MD=-63.97,95%CI(-64.98,-62.96),P〈0.00001;AST:MD=-55.14,95%CI(-56.52,-53.76),P〈0.00001].(2)Carnitine for epileptic children who had high risk factors of liver injury using VPA could decrease concentration of ALT and AST[ALT:MD=-12.53,95%CI(-15.32,-9.75),P〈0.00001;AST:MD=-19.45,95%CI(-36.50,-2.40),P=0.03]. Conclusion Current evidence suggests that carnitine improves the liver function indicators with fewer adverse reactions and decreases concentration of ammonia,and improves the life quality of patients. However,due to the limited quantity and quality of the included studies,more multi-center high quality RCTs with large sample size are needed to verify the above conclusion.
作者 黄宗瑶 罗蓉 张川 蒋璐灿 黄亮 张伶俐 HUANG Zong-yao , LUO Rong , ZHAN G Chuan , et al.(Department of Pharmacy,Evidence-based Pharmacy Center,Key Laboratory of Birth Dejects and Related Diseases of Women and Children (Ministry of Education ), West China Second Hospital, Sichuan University , Chengdu 610041,China)
出处 《中国实用儿科杂志》 CSCD 北大核心 2018年第8期626-632,共7页 Chinese Journal of Practical Pediatrics
关键词 左卡尼汀 卡尼汀 丙戊酸 癫痫儿童 系统评价 L-camitine carnitine valproic acid epileptic children systematic review
作者简介 通讯作者:张伶俐,电子信箱:zhanglingli@seu.edu.cn
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