| Background:Epilepsy is a widespread brain disease worldwide.There are tens of millions of epilepsy patients worldwide,of which about 9 million live in China.The continuous improvement of living standards and medical and health conditions has led to more epilepsy patients who have not been properly diagnosed and treated,which means that more individualized treatment and quality of life of epilepsy patients should be paid attention to.At present,there are anti-epileptic medications,surgical treatments,and dietary treatments that can be used to treat epilepsy.Gene therapy is expected in the future.The main force of treatment is still the standardized use of antiepileptic drugs（AEDs）,and most patients can reduce/stop epileptic seizures through the use of an AED.However,as a chronic disease,the treatment time of AED is mostly several years or even life.Long-term treatment of AEDs has significantly increased the side effects of drugs,except for some common adverse reactions such as nausea,vomiting,dizziness,drowsiness,thrombocytopenia and liver damage,and its impact on bone safety is gradually being understood.During the treatment process,minor bone abnormalities will not have obvious clinical symptoms,so it is not easy to be noticed.According to reports,more than half of epilepsy patients treated with AEDs have skeletal abnormalities,which are manifested in changes in the bone turnover process,decreased bone density and increased fracture risk,and eventually osteoporosis.A large number of studies have confirmed that the drugs carbamazepine（CBZ）and phenobarbital,which can induce liver cell enzymes,can significantly affect bone metabolism and endanger bone health.Sodium valproate（VPA）may endanger bone safety by directly affecting bone cells and hormone levels.New AEDs,such as oxcarbazepine（OXC）and levetiracetam（LEV）,benefit from their smaller negative effects and drug interactions,and are widely used in clinical applications,but their impact on bone health is currently under investigation.A unified result has not yet been achieved.Objective:To study the effects of AEDs（VPA,LEV,OXC）on the levels of 25（OH）D3and bone turnover specific markers（PINP,β-CTX）in adult patients with epilepsy,and further explore the differences in bone metabolism of the same drug at different time of administration.Provide a certain basis and guidance for the individualized selection of AEDs and monitoring of AEDs related bone status in clinical practice.Methods:A total of 115 adult epilepsy patients who were treated at the Department of Neurology,Affiliated Hospital of Yan’an University from December 2019 to March 2021and took VPA,LEV,and OXC monotherapy for≥6 months were selected as the observation group.They were grouped according to the types of oral drugs:there were 39cases in the VPA group,41 cases in the LEV group,and 35 cases in the OXC group;according to the different groups of medication time,the medication time was less than 1.5years:18 cases of VPA,19 cases of LEV,18 cases of OXC;time of medication≥1.5 years:21 cases of VPA,22 cases of LEV,17 cases of OXC.57 cases of epilepsy patients who had not taken any anti-epileptic drugs served as the control group.Collect the relevant clinical information of these patients（age,gender,duration of medication）,bone metabolism regulating hormone:25（OH）D3 and bone turnover indicators:bone formation marker PINP and bone resorption markerβ-CTX.Results:1.There is no significant difference in general information（age,sex）between the observation group and the control group,and there is no significant difference in age,sex,and duration of medication between the observation group.2.The serum 25（OH）D3,PINP andβ-CTX of the three groups of patients in the VPA group,LEV group and OXC group were compared with those of the control group.The results showed that there was no significant difference between 25（OH）D3 in the VPA group and the control group（P>0.05）),bone turnover indicators PINP andβ-CTX were higher than the control group,and the difference was significant（P<0.05）;the LEV group25（OH）D3,PINP andβ-CTX were not significantly different from the control group（P>0.05）;25（OH）D3 in the OXC group was lower than the control group,and the difference was significant（P<0.05）,and there was no significant difference between PINP andβ-CTX and the control group（P>0.05）.3.25（OH）D3,PINP andβ-CTX were compared between the observation groups.The results showed that the bone turnover indexes PINP andβ-CTX of the VPA group were higher than those of the LEV group and the OXC group,and the difference was significant（P<0.05）,There was no significant difference in 25（OH）D3 between VPA group and LEV group（P>0.05）;There was no significant difference in PINP andβ-CTX between LEV group and OXC group（P>0.05）;25（OH）D3 in OXC group was lower than that in VPA and LEV group,and the difference was significant,and the difference was significant（P<0.05）.4.The general data（age and gender）of each drug observation group at different duration of medication were matched（P>0.05）.PINP andβ-CTX for VPA taking more than 1.5years were higher than those of epilepsy patients treated with short-term（dose less than1.5 years）,the difference was significant（P<0.05）,and there was no significant difference between the two in 25（OH）D3.There was no significant difference in 25（OH）D3,PINP andβ-CTX in patients with OXC and LEV taking medication for more than one and a half years compared with short-term treatment（P>0.05）.Conclusion:1.VPA increases bone turnover indicators（PINP,β-CTX）,and the longer the medication,the more obvious the increase,which may cause the bone tissue to continue to be in a high turnover state,causing harm to bone metabolism and bone safety,and the longer the treatment time,The more obvious the impact;2.OXC reduces the level of 25（OH）D3,which may affect bone tissue metabolism and endanger bone health;3.LEV has no effect on 25（OH）D3and bone turnover indexes（PINP,β-CTX）. |
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