항경련제의 장기투여가 혈장 PIVKA-Ⅱ 및 간기능에 미치는 영향

The Effects of Long-term Antiepileptic Drug Therapy of Plasma PIVKA-Ⅱ and Liver Function

It was reported that plasma PIVKA-Ⅱ(protein induced by vitamin K absence or antagonistⅡ) levels in infants born to mothers treated with antiepileptic d겨gs pregnancy increased markedly, but little has been studied on the effect of the drugs on plasma PIVKA-Ⅱ in epileptic patients We measured PIVKA-Ⅱ levels by means of latex agglutination method in epileptic children receiving a variety of antiepileptic drugs, and assessed the incidence of PIVKA-Ⅱ positivity(plasma levels above 1&micro;g/ml) together with a correlation between the plasma level of PIVKA-Ⅱ and the particular anticonvulsant taken, duration of the treatment, age of patients, and the values of liver function test. The study included 97 epileptic patients(54 males, 43 females; age 5-23 years) who were divided into four antiepileptic drug-treated groups : valproic acid monotherapy(n=18), carbamazepine monotherapy(n=38), valproic acid polytherapy(n=20) and other antiepileptic drugs(n=21), and a control group ofn 52 children(33 males, 19 females; ages 8-19years). The results were as follows; 1) The incidence rate of PIVKA-Ⅱ positivity was 21.6% in 97 patients of four antiepileptic drug-teated groups. 2) There was neither correlation between PIVKA-Ⅱ positivity and any specific antiepileptic drugs nor between PIVKA-Ⅱ positivity and the duration of the treament. 3) There was an inverse correlation between the age of the patients and PIVKA-Ⅱ levels(P=0.028). 4) Among the biochemical studies of liver function, only the lvel of blood ammonia was correlated with the level of PIVKA-Ⅱ(P<0.00001). It could be concluded that the raised PIVKA-Ⅱ level in patients on antiepileptic treatment was presumptive evidence for subclinical coagulation defect, similar to that found in vitamin K deficiency, and the measurement of blood ammonia may be the useful adjuvant method to predict raised plasma PIVKA-Ⅱ level.