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CNS Drugs:丙戊酸治疗2年后 还有必要进行年度实验室随访吗?

2018-01-04 易湛苗 环球医学

2017年发表在《CNS Drugs》上的一项系统回顾,对丙戊酸(VPA)治疗的患者年度实验室随访的必要性进行了考察。

2017年发表在《CNS Drugs》上的一项系统回顾,对丙戊酸(VPA)治疗的患者年度实验室随访的必要性进行了考察。

背景:VPA治疗的患者年度实验室随访的必要性存在争议。

目的:旨在调查VPA治疗的患者中,肝酶、电解质和全血计数(FBC)的年度实验室随访的必要性。

患者和方法:2016年12月对循证医学评论(EBMR)、Medline和Embase进行了一项系统性的检索,旨在识别出调查或引用丙戊酸、肝功能紊乱、电解质紊乱、FBC偏差的已发表的所有文献。

结果:本综述纳入了108篇文献。由于参与者的数量和研究时间在多数研究中不充足,所以难以检测到罕见的不良事件,因此研究并未证实显着的肝毒性患病率。虽然转氨酶短暂升高是常见的、通常无害,但严重肝毒性是一个罕见的现象,并且常规试验室监测不能预防。VPA对血清钙、钠、钾和白蛋白无相关影响。FBC的发病率范围为从0.6%到27.8%,多数在治疗的前2年发生,且通常无症状。

结论:长期监测VPA仅在有剂量调整、联合用药转换或有合并症的时候是必要的。在非复杂性病例中,VPA治疗2年后可以停止年度实验室随访。在肝毒性的检测中,鼓励患者提高警惕比实验室检查更有效。开始VPA治疗后的3~6个月、1年和2年时,以及增加VPA剂量或存在相互作用的药物后,随访FBC就足够。

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    2018-04-24 lg.zhao
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    2018-12-13 tsing_hit
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