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目的观察托吡酯的持续接受治疗率,衡量疗效不佳和耐受性的综合情况,为临床合理应用托吡酯提供依据。方法采用前瞻性临床研究方法观察病例87例,应用Kap lan-M e ier生存率分析曲线,评估癫痫患者托吡酯的持续接受治疗率,用Cox回归分析影响患者持续接受托吡酯治疗时间的相关因素。结果47.6%的患者放弃了治疗,平均托吡酯治疗时间为798.7d。Kap lan-M e ier生存率分析曲线显示1年继续保持托吡酯治疗率约为72%,2年及3年的继续治疗率分别为53%和43%。≤12岁的患者组其托吡酯持续治疗率高于>12岁患者,两组曲线log rank比较P<0.05。合用2种或以上的抗癫痫药物及最大剂量是影响托吡酯持续治疗时间的重要因素,癫痫发作类型、性别及病因等均不是影响托吡酯停用与否的显著性因素。结论合用2种或以上其他的抗癫痫药物易导致患者放弃托吡酯治疗;适当增加托吡酯剂量以提高疗效,能延长持续治疗时间。
Objective To observe the continuous treatment rate of topiramate, to measure the comprehensive effect of poor efficacy and tolerance, and to provide a basis for clinical application of topiramate. Methods A prospective clinical study was performed in 87 cases. The Kaplan-Meier survival analysis was used to evaluate the continuous treatment rate of topiramate in epilepsy patients. Cox regression analysis was used to analyze the influencing factors on patients’ sustained duration of topiramate treatment. Results 47.6% of patients gave up treatment, the average duration of topiramate treatment 798.7d. The Kaplan-Meier survival analysis showed that the rate of topiramate treatment remained about 72% at 1 year, and 53% at 43 and 2% at 2 and 3 years, respectively. Persons ≤12 years of age had higher sustained-dose rates of topiramate than those> 12 years of age, with a log-rank comparison of the two groups P <0.05. Combination of two or more antiepileptic drugs and the maximum dose is an important factor affecting the duration of topiramate treatment, epileptic seizures, gender and etiology are not significant factors that affect the disabled topiramate. Conclusions Combination of two or more other antiepileptic drugs can easily lead to the abandonment of topiramate treatment. Appropriate increase of topiramate dosage can improve the curative effect and extend the duration of continuous treatment.