| Objective HLA-B*1502 gene was detected in patients with epilepsy by oral carbamazepine.The correlation between HLA-B*1502gene and carbamazepine-induced drug eruption was analyzed to evaluate the application of HLA-B*1502 gene detection to oral carbamazepine.The safety of carbamazepine epilepsy patients.Through cost-effectiveness analysis,the HLA-B*1502 gene was evaluated to guide the economics of carbamazepine anti-epileptic treatment.Methods From January 2016 to April 2017,patients with epilepsy who met the enrollment conditions in the Department of Neurology and Dermatology of the First People's Hospital of Chenzhou City were enrolled,and the peripheral blood DNA of the patients was extracted and sent to Wuhan Kangshengda Medical Laboratory.Sequencing was performed to analyze the correlation between genotype and drug eruption..Using the method of comparative analysis,from May 2017 to April 2018,patients with epilepsy who were only treated with carbamazepine orally and sodium valproate in the same hospital wereenrolled in the groupA(oral carbamazepine),regimen B(oral sodium valproate)and gene guidance group C regimen(HLA-B*1502 gene test negative oral carbamazepine)and epilepsy that only met valproate meet the inclusion criteria Patients were enrolled in the group,and the follow-up and questionnaires were used to compare the treatment effects,compliance and costs of the three groups.Results1.In the first part of the study,105 patients with epilepsy who met the enrollment criteria were tested.Pearson chi-square test was used to test the gender of all enrolled patients(P=0.522),urban-rural distribution(P=0.569),etiology(P=0.968),seizure type.(P=0.458)had no correlation with HLA-B*1502 gene test results(P>0.05).2.The total positive rate of HLA-B*1502 gene test was 14.29%(15/105).Twelve patients with epilepsy had drug eruption.The incidence of drug eruption was 11.43%(12/105),among which the incidence of light drug eruption was 6.67%(7/105),the incidence of moderate-to-severe drug eruption was 4.76%(5/105);the incidence of drug rash in HLA-B*1502 gene-positive patients was 91.67%(11/12),and the incidence of drug-borne rash was 8.33%(1)./12);The positive rate of HLA-B*1502 gene in drug-free group was 3.81%(4/105),and the negative rate was 88.57%(93/105).3.The study found that the average medication time for patientswith drug eruption was 0.052 ± 0.034 years(ie,6-30 days),and the average medication time for patients without drug eruption was1.75 ? 1.08 years.There was a statistically significant difference between the two groups(F=29.335,P< 0.01).4.The second part of the study found that the gene guidance C program and the control A program,B program in gender(P = 0.118),age(P = 0.725),urban-rural distribution(P = 0.063)and disease course(P =0.993),there is no statistical difference.(P>0.05).5.The total effective rate of the gene guidance C program was higher than that of the A program(P=0.04),and the total efficiency of the B program was higher(P=0.034).The efficiency was higher than the total efficiency of the A program(P=0.006),and the difference was statistically significant(P<0.05).6.The cost-effectiveness ratio of the gene guidance C program is7822.99 yuan,which is more economical than the A program 12253.89 yuan and the B program 12165.01 yuan.The statistical difference between the three is significant(T=7.347,P=0.018<P=0.05)..Conclusions1.The drug eruption caused by carbamazepine usually occurs within1 month after administration and has strong correlation with HLA-B*1502 gene.2.HLA-B*1502 gene guides antiepileptic treatment safer and costeffective... |
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