癫痫与心血管疾病（cardiovascular disease,CVD）互为因果,癫痫可增加CVD的发生率和死亡率,而CVD可诱发癫痫猝死。不同的抗癫药物对CVD危险因素的影响各异,这些危险因素包括体质量、胰岛素抵抗、代谢综合征、血清尿酸水平、颈动脉内膜中层厚度和氧化应激标志物等。鉴于部分抗癫药物可能增加或降低CVD发生风险,因此在实施个体化的抗癫痫治疗时,对于有较高CVD发生风险的癫痫患者应选择合适的抗癫痫药物,同时合理使用可降低CVD发生风险的药物。
Abstract
There is a reciprocal causal relationship between epilepsy and cardiovascular disease (CVD), which means that epilepsy may increase the incidence rate and mortality of CVD, while the CVD may induce the sudden unexpected death in epilepsy. Different antiepileptic drugs have different effects on the risk factors of CVD including body weight, insulin resistance, metabolic syndrome, serum uric acid level, carotid artery intima-media thickness and markers of oxidative stress. In view of the fact that some antiepileptic drugs may increase or reduce the risk of occurrence of CVD, therefore, in individualized antiepileptic therapy, appropriate antiepileptic drugs should be selected for patients with high risk of CVD, meanwhile, the rational use of drugs which can reduce the risk of CVD is recommended.
关键词
癫痫 /
癫痫猝死 /
抗癫痫药物 /
心血管疾病 /
危险因素
Key words
Epilepsy /
Sudden unexpected death in epilepsy /
Antiepileptic drugs /
Cardiovascular disease /
Risk factors
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] WU Y, LIU D, SONG Z. Neuronal networks and energy bursts in epilepsy[J]. Neuroscience, 2015(287):175-186.
[2] CONRAD J, PAWLOWSKI M, DOGAN M, et al. Seizures after cerebrovascular events: risk factors and clinical features[J]. Seizure, 2013, 22(4):275-282.
[3] ATHYROS V G, KAKAFIKA A I, PAPAGEORGIOU A A, et al. Effect of a plant stanol ester-containing spread, placebo spread, or Mediterranean diet on estimated cardiovascular risk and lipid, inflammatory and haemostatic factors[J]. Nutr Metab Cardiovasc Dis, 2011, 21(3):213-221.
[4] LAMBERTS R J, BLOM M T, WASSENAAR M, et al. Sudden cardiac arrest in people with epilepsy in the community: Circumstances and risk factors[J]. Neurology, 2015, 85(3):212-218.
[5] BROTHERSTONE R, BLACKHALL B, MCLELLAN A. Lengthening of corrected QT during epileptic seizures[J]. Epilepsia, 2010, 51(2):221-232.
[6] GOLDMAN A M, GLASSCOCK E, YOO J, et al. Arrhythmia in heart and brain: KCNQ1 mutations link epilepsy and sudden unexplained death[J]. Sci Transl Med, 2009, 1(2):2ra6.
[7] JEHI L, SCHUELE S. Sudden death in epilepsy Where is the “heart” of the problem?[J]. Neurology, 2015, 85(3):208-209.
[8] TOLSTYKH G P, CAVAZOS J E. Potential mechanisms of sudden unexpected death in epilepsy[J]. Epilepsy Behav, 2013, 26(3):410-414.
[9] LA ROVERE M T. Baroreflex sensitivity as a new marker for risk stratification[J]. Z Kardiol, 2000(89 Suppl 3):44-50.
[10] AHIRWAR A K, JAIN A, SINGH A, et al. The study of markers of endothelial dysfunction in metabolic syndrome[J]. Horm Mol Biol Clin Investig, 2015, 24(3):131-136.
[11] TSOULI S G, LIBEROPOULOS E N, MIKHAILIDIS D P, et al. Elevated serum uric acid levels in metabolic syndrome: an active component or an innocent bystander?[J]. Metabolism, 2006, 55(10):1293-1301.
[12] PATETSIOS P, RODINO W, WISSELINK W, et al. Identification of uric acid in aortic aneurysms and atherosclerotic artery[J]. Ann N Y Acad Sci, 1996(800):243-245.
[13] SIEFERT S A, SARKAR R. Matrix metalloproteinases in vascular physiology and disease[J]. Vascular, 2012, 20(4):210-216.
[14] PYLVÄNEN V, KNIP M, PAKARINEN A J, et al. Fasting serum insulin and lipid levels in men with epilepsy[J]. Neurology, 2003, 60(4):571-574.
[15] SVALHEIM S, LUEF G, RAUCHENZAUNER M, et al. Cardiovascular risk factors in epilepsy patients taking levetiracetam, carbamazepine or lamotrigine[J]. Acta Neurol Scand Suppl, 2010(190):30-33.
[16] ZENG K, WANG X, XI Z, et al. Adverse effects of carbamazepine, phenytoin, valproate and lamotrigine monotherapy in epileptic adult Chinese patients[J]. Clin Neurol Neurosurg, 2010, 112(4):291-295.
[17] LUEF G, RAUCHENZAUNER M, WALDMANN M, et al. Non-alcoholic fatty liver disease (NAFLD), insulin resistance and lipid profile in antiepileptic drug treatment[J]. Epilepsy Res, 2009, 86(1):42-47.
[18] RING H A, HELLER A J, MARSHALL W J, et al. Plasma uric acid in patients receiving anticonvulsant monotherapy[J]. Epilepsy Res, 1991, 8(3):241-244.
[19] FILIPPATOS T D, KIORTSIS D N, LIBEROPOULOS E N, et al. Effect of orlistat, micronised fenofibrate and their combination on metabolic parameters in overweight and obese patients with the metabolic syndrome: the FenOrli study[J]. Curr Med Res Opin, 2005, 21(12):1997-2006.
[20] ATHYROS V G, MIKHAILIDIS D P, LIBEROPOULOS E N, et al. Effect of statin treatment on renal function and serum uric acid levels and their relation to vascular events in patients with coronary heart disease and metabolic syndrome: a subgroup analysis of the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) Study[J]. Nephrol Dial Transplant, 2007, 22(1):118-127.
[21] DEROSA G, MAFFIOLI P. Effects of amlodipine plus atorvastatin association in hypertensive hypercholesterolemic patients[J]. Expert Rev Cardiovasc Ther, 2010, 8(6):835-843.
[22] DASKALOPOULOU S S, ATHYROS V G, ELISAF M, et al. The impact of serum uric acid on cardiovascular outcomes in the LIFE study[J]. Kidney Int, 2004, 66(4):1714-1715.
[23] YUEN A W, SINGH R, BELL G S, et al. The long-term retention of pregabalin in a large cohort of patients with epilepsy at a tertiary referral centre[J]. Epilepsy Res, 2009, 87(2-3):120-123.
[24] SCHERNTHANER G. Pleiotropic effects of thiazolidinediones on traditional and non-traditional atherosclerotic risk factors[J]. Int J Clin Pract, 2009, 63(6):912-29.
[25] FILIPPATOS T D, KIORTSIS D N, LIBEROPOULOS E N, et al. A review of the metabolic effects of sibutramine[J]. Curr Med Res Opin, 2005, 21(3):457-466.
[26] DASKALOPOULOU S S, ATHYROS V G, ELISAF M, et al. Uric acid levels and vascular disease[J]. Curr Med Res Opin, 2004, 20(6):951-954.
[27] CHUANG Y C, CHUANG H Y, LIN T K, et al. Effects of long-term antiepileptic drug monotherapy on vascular risk factors and atherosclerosis[J]. Epilepsia, 2012, 53(1):120-128.
[28] OZ O, GÖKÇIL Z, BEK S, et al. Is asymmetric dimethylarginine responsible for the vascular events in patients under antiepileptic drug treatment?[J]. Epilepsy Res, 2009, 87(1):54-58.
[29] AYCICEK A, ISCAN A. The effects of carbamazepine, valproic acid and phenobarbital on the oxidative and antioxidative balance in epileptic children[J]. Eur Neurol, 2007, 57(2):65-69.
PDF(1387 KB)
