卡马西平单药治疗与癫痫患者血浆同型半胱氨酸水平间关系的meta分析

Meta-analysis of the Relationship Between Plasma Homocysteine Levels and Carbamazepine Monotherapy in Epileptic Patients

关键词:  癫痫  卡马西平  同型半胱氨酸  meta分析

Key words:  epilepsy  carbamazepine  homocysteine  meta-analysis

摘要:

目的 探讨卡马西平单药治疗与癫痫患者血浆同型半胱氨酸水平变化间的关系。方法 以卡马西平、同型半胱氨酸、癫痫、carbamazepine、homocysteine、epilepsy和epilep*为检索词，检索建库至2016年3月维普网（VIP）、万方数据库、中国知网（CNKI）以及Cochrance图书馆、美国国立医学图书馆（PubMed）、科学引文索引数据库（Web of Science）、荷兰医学文摘（EMBASE）等数据库，查找卡马西平与血浆同型半胱氨酸相关文献，使用Newcastle-Ottawa量表对筛选所得文献进行质量评价，采用RevMan 5.2软件对相关数据进行统计学分析。结果 共纳入符合条件的中英文文献22篇，其中中文文献9篇，英文文献13篇。纳入研究对象总计1 604例，其中病例组575例，正常对照组1 029例。Meta分析显示，卡马西平单药治疗组患者血浆同型半胱氨酸水平显著高于正常对照组[SMD=1.55，95%CI：[1.09，2.01]，P<0.000 01]；经异质性检验存在明显的异质性（P<0.000 01；I²=93%），按照地域差别和受试者年龄差异进行亚组分析，结果显示西亚组癫痫患者异质性风险（I²=58%，P=0.07）较全体（I²=93%，P<0.000 01）显著降低。使用Stata 12.0统计软件进行敏感性分析，结果表明稳定性良好。采用漏斗图法、Begg法对meta分析的发表偏倚进行检测，结果显示，漏斗图基本对称，Pr>|Z|=0.091>0.05（无统计学意义），提示本研究不存在明显发表偏倚。失安全系数（Nfs）0.05为7 269.16（P=0.05），提示需加入约7 269个阴性结果的研究才能推翻本研究的结论。结论 卡马西平单药治疗对癫痫患者血浆同型半胱氨酸的代谢存在影响，可明显增加癫痫患者血浆同型半胱氨酸水平，适当补充叶酸、维生素B₁₂和维生素B₆以降低同型半胱氨酸水平可能对在服卡马西平的癫痫患者有益。

Abstract:

OBJECTIVE To evaluate the relationship between carbamazepine(CBZ) monotherapy and plasma homocysteine(Hcy) levels in epileptic patients. METHODS Articles concerning the homocysteine levels in carbamazepine monotherapy patients with epilepsy and published from building a database to March 2016 through VIP, Wanfang, CNKI, Cochrance Library, PubMed, Web of Science, EMBASE by searching the key words of carbamazepine, homocysteine, epilepsy and epilep*. The quality of controlled clinical trials (CCT) found in the study was assessed by the Newcastle-Ottawa scale(NOS), the relevant data of included studies were performed through RevMan 5.2 software.RESULTS A total of 22 eligible studies were enrolled in this meta-analysis, including 9 Chinese literature and 13 English literature. The study included a total of 1 604 cases, including 575 cases of patient group and normal control group 1 029 cases. Results of meta-analysis showed that plasma homocysteine levels in CBZ treated patients with epilepsy were higher than healthy control group [SMD=1.55, 95% CI: [1.09, 2.01], P<0.000 01], there was significant heterogeneity in the estimates according to I² test (P<0.000 01; I²=93%). Futher subgroup analysis showed that no significant difference was present when grouped by regional and age, but the risk of heterogeneity in West Asian group(I²=58%, P=0.07) was diminished when compared with overall groups (I²=93%, P<0.000 01). The result of sensitivity analysis by Stata 12.0 showed good stability. Using the funnel plot method, Begg method for meta-analysis to detect publication bias, the results showed substantially symmetrical funnel plot, Pr>|Z|=0.091>0.05 (no statistical significance), suggesting that the study there was no significant publication bias. Loss factor of safety (Nfs) 0.05 equaled 7 269.16 (P=0.05), required the addition of about 7 269 negative results of the study in order to overthrow the conclusions of this study. CONCLUSION Carbamazepine monotherapy presence on the metabolism of plasma homocysteine in patients with epilepsy, the seizures significantly rise plasma homocysteine levels, appropriate to add folic acid, vitamin B₁₂ and vitamin B₆ to reduce homocysteine may be beneficial for patients with epilepsy taking carbamazepine.