Clinical Significance of the Changes of Amino Acid in Children with Epilepsy on Valproate Monotherapy / 现代检验医学杂志

ABSTRACT

Objective To provide laboratory diagnosis for clinical monitoring of VPA hepatotoxicity,this study explored the levels of amino acid in children with epilepsy on valproate monotherapy.Methods The disease subjects were selected from 178 children with epilepsy treated by VPA only in Beijing Children's Hospital from June 2015 to February 2017,and the control subjects were selected from 178 healthy children with age-and sex-matched.The baseline clinical data and liver and renal function results were collected.The concentrations of VPA in children were monitored by fluorescence polarization immunoassay,the levels of amino acids in the blood dry spot were detected by liquid chromatography tandem mass spectrometry.The levels of amino acids between the disease group before and after VPA therapy and the control group were com pared.Results Compared with controls,there was no significant difference in the level of urea and creatinine between patients before and after VPA treatment (F=0.187～ 0.970,P＞0.05).Compared with the control group and the patients before VPA treatment,the levels of ALT,AST and γ-GT of the patients after VPA treatment increased obviously (F=3.547 ～ 16.181,P＜0.05).Compared with the control group and before VPA treatment,the levels of Cys,Gln,Glu,Gly,Leu and Lys (F=3.489～ 71.896,P＜0.05) in the blood of children with epilepsy after VPA treatment were significantly different.The levels of Cys,Gln,Glu,Gly,VPA and Lys in the blood of the children with epilepsy treated by VPA were significantly higher than those in the control group and before VPA treatment,but the level of Leu was lower than that of the control group and before treatment with VPA.Conclusion The increases of ALT,AST and γ-GT indicated that VPA or its metabolites induced liver injury of patients.In the early stage of VPA hepatotoxicity,the levels of amino acid in children had changed obviously,so detection of amino acid may be a sensitive index to reflect the hepatotoxicity of VPA.Regular examination of amino acid in children after VPA treatment may be helpful for the clinical monitoring of hepatotoxicity caused by VPA.