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目的:评价托吡酯对癫痫儿童骨代谢的影响。方法:计算机检索Pub Med、Ovid、Wily Online Library、Elsevier Science Direct、Cochrane Library、中国知网期刊全文数据库、维普中文科技期刊数据库、万方数据库及中国生物医学文献数据库,检索数据库的时间设为从建库至2014年5月。纳入托吡酯对癫痫儿童骨代谢影响的文献,采用Rev Man 5.2软件进行Meta分析。结果:8篇文献纳入Meta分析,均为病例对照研究,累计给药组287例,对照组239例。Meta分析结果显示,托吡酯组血清钙离子浓度[SMD=1.57,95%CI(-0.21,3.36)]、血清磷离子浓度[SMD=-0.06,95%CI(-0.43,0.31)]、血清碱性磷酸酶(ALP)浓度[SMD=0.51,95%CI(-0.11,1.14)]和骨碱性磷酸酶(BAP)浓度[SMD=1.31,95%CI(-0.14,2.76)]与对照组比较差异均无统计学意义(P>0.05);托吡酯组尿脱氧吡啶啉(DPD)/肌肝(Cr)水平高于对照组[SMD=1.13,95%CI(0.28,1.97)],差异有统计学意义(P<0.01);托吡酯组骨密度(BMD)含量低于对照组[SMD=-0.51,95%CI(-0.94,-0.10)],差异有统计学意义(P<0.05)。结论:托吡酯对癫痫儿童尿DPD/Cr水平和BMD有影响,应定期复查,防止骨损害的发生。
Objective: To evaluate the effect of topiramate on bone metabolism in children with epilepsy. Methods: The databases of Pub Med, Ovid, Wily Online Library, Elsevier Science Direct, Cochrane Library, China Knowledge Online Journal Full-text Database, VIP Chinese Science and Technology Periodical Database, Wanfang Database and China Biomedical Literature Database were searched by computer. Construction of the library until May 2014. The literature that included topiramate on the bone metabolism in children with epilepsy was analyzed by Meta-analysis using Rev Man 5.2 software. Results: Eight articles were included in the meta-analysis. All of them were case-control studies, with a total of 287 cases in the administration group and 239 cases in the control group. Meta analysis showed that serum calcium concentration in topiramate group (SMD = 1.57,95% CI -0.21,3.36), serum phosphorus concentration [SMD = -0.06,95% CI (-0.43,0.31)], (SMD = 0.51, 95% CI (-0.11, 1.14)] and bone alkaline phosphatase (BAP) concentrations [SMD = 1.31,95% CI (-0.14,2.76)] compared with the control group (P> 0.05). The levels of DPD / Cr in the topiramate group were higher than those in the control group [SMD = 1.13,95% CI (0.28,1.97)], the differences were statistically significant (P <0.01). The BMD of topiramate group was lower than that of the control group [SMD = -0.51,95% CI (-0.94, -0.10)], the difference was statistically significant (P <0.05). Conclusion: Topiramate has effects on urinary DPD / Cr level and BMD in children with epilepsy. It should be regularly reviewed to prevent bone damage.