作者：李燕楚1，王曼2

单位：

1.221000江苏省徐州市第一人民医院老年医学科　2.221000江苏省徐州市第一人民医院肿瘤科

Units：

1.Department of Geriatrics, Xuzhou First People's Hospital, Xuzhou 221000, China 2.Department of Oncology, Xuzhou First People's Hospital, Xuzhou 221000, China

关键词：

　癫痫；抑郁；老年人；左乙拉西坦；迷走神经刺激；认知功能；炎性反应；神经递质

Keywords：

Epilepsy; Epression; Aged; Levetiracetam; Vagal nerve stimulations; Cognitive function; Inflammatory response; Neurotransmitter

CLC：

R 742.1 R 749.42

DOI：

10.12114/j.issn.1008-5971.2021.00.292

Funds：

摘要：

　背景　老年癫痫患者易并发抑郁，而抑郁又会影响患者的预后。左乙拉西坦虽能改善癫痫患者的临 床症状，但在抗抑郁方面仍需要辅助其他治疗方案。目的　探讨左乙拉西坦联合迷走神经刺激治疗老年癫痫合并抑郁 患者的临床疗效及其对认知功能、炎性反应、神经递质的影响。方法　选取2018年3月至2021年1月徐州市第一人民医 院收治的98例老年癫痫合并抑郁患者，采用随机数字表法将其分为对照组和研究组，每组49例。对照组患者采用左乙 拉西坦治疗，研究组患者在对照组治疗基础上采用迷走神经刺激治疗。比较两组患者治疗6个月后McHuGH分级，治 疗前、治疗6个月后汉密尔顿抑郁量表（HAMD）评分、蒙特利尔认知评估量表（MoCA）评分及血清炎性因子〔白介 素6（IL-6）、肿瘤坏死因子α（TNF-α）〕、神经递质〔5-羟色胺（5-HT）、多巴胺（DA）〕水平；并记录两组 患者治疗期间不良反应发生情况。结果　治疗6个月后研究组患者McHuGH分级优于对照组，HAMD评分低于对照组， MoCA评分高于对照组（P＜0.05）。治疗6个月后研究组患者血清IL-6、TNF-α水平低于对照组，血清5-HT、DA水平 高于对照组（P＜0.05）。两组患者治疗期间不良反应发生率比较，差异无统计学意义（P＞0.05）。结论　左乙拉西 坦联合迷走神经刺激治疗老年癫痫合并抑郁患者的临床疗效确切，能有效提高患者癫痫治疗效果并减轻抑郁程度，此 外还能改善患者认知功能，减轻炎性反应，提高神经递质水平，且未增加不良反应发生风险，安全性较高。

Abstract：

Backgroud Elderly patients with epilepsy are prone to depression, and depression will affect the prognosis of patients. Although levetiracetam can improve the clinical symptoms of patients with epilepsy. However, in terms of antidepressant, other treatment options are still needed. Objective To investigate the clinical effect of levetiracetam combined with vagal nerve stimulations in the treatment of elderly patients with epilepsy complicated with depression and its effects on cognitive function, inflammatory response and neurotransmitters. Methods A total of 98 elderly patients with epilepsy complicated with depression who were admitted to Xuzhou First People's Hospital from March 2018 to January 2021 were selected, and they were divided into control group and study group by random number table method, with 49 cases in each group. The control group was treated with levetiracetam, and the study group was treated with vagal nerve stimulations based on the control group. McHuGH grade at 6 months after treatment, Hamilton Depression Scale (HAMD) score, Montreal Cognitive Assessment Scale (MoCA) score, serum levels of inflammatory factors [interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) ] and neurotransmitters [5-hydroxytryptamine (5-HT) and dopamine (DA) ] before treatment and at 6 months after treatment were compared between the two groups; and the adverse reactions of the two groups were recorded during the treatment. Results At 6 months after treatment, the McHuGH grade of the study group was better than that of the control group, the HAMD score was lower than that of the control group, and the MoCA score was higher than that of the control group (P 0.05) . Conclusion The clinical effect of levetiracetam combined with vagal nerve stimulations in the treatment of elderly patients with epilepsy complicated with depression is effective, it can effectively improve the treatment effect of epilepsy and reduce the degree of depression. In addition, it can improve patients' cognitive function, reduce inflammatory reaction and improve the neurotransmitters level. It does not increase the risk of adverse events, and has high safety.

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