Fetal hydantoin syndrome: current status.
Fetal hydantoin syndrome: current status.
复制标题
胎儿乙内酰脲综合征：现状。
DOI：
10.1016/s0022-3476(82)80339-9
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发表时间：
1982
期刊：
影响因子：
--
通讯作者：
B. Buehler
中科院分区：
文献类型：
--
作者：
J. Hanson;B. Buehler
自第一种抗惊厥药物苯巴比妥问世以来的70年里，已经开发了一大批多样化的药物来控制癫痫发作。这些药物中最有效和使用最广泛的是苯妥英(苯妥英，海因)，一种临床使用了40多年的药物。据估计，美国有200万患者长期服用苯妥英钠/存在大量文献，说明患有惊厥障碍的母亲的后代发生胎儿异常的风险。在所有这些流行病学研究中，接受癫痫治疗的妇女的后代中异常的频率已经超过了正常(非癫痫)对照组的后代(表)。2~6在大多数情况下，这种差异在统计学上是显著的，相对风险估计在2到3之间。不幸的是，这些研究中的样本量对于任何可靠的结论都是微不足道的，在所有研究中，样本量不足以允许按几个以上的母系或父系变量进行分层，并且药物治疗或惊厥障碍的所有组合都已被一起分析。对药物暴露的剂量和时间的考虑尚未具体说明。流行病学研究迄今未能回答这个问题：接受治疗的癫痫妇女的后代中先天异常的风险与药物治疗有关，还是与潜在的惊厥障碍或遗传因素有关？两个研究领域表明，风险增加的一部分可能归因于药物治疗。如表所示，在回顾研究中，接受癫痫治疗的妇女的后代中异常的频率始终高于
IN THE 70 YEARS since the introduction of the first anticonvulsant, phenobarbital, a large and diverse group of drugs has been developed to control seizures. Among the most efficacious and widely used of these agents is phenytoin (Dilantin, hydantoin), an agent in clinical use for more than 40 years. It has been estimated that two million patients in the United States receive phenytoin on a long-term basis/Extensive literature exists regarding the magnitude of risk for fetal abnormality in the offspring of mothers with convulsive disorders. In all of these epidemiologic studies, the frequency of abnormalities in the offspring of treated epileptic women has exceeded that for offspring of normal (nonepileptic) controls (Table). 2~ 6 In most cases this difference has been statistically significant, with relative risk estimates ranging from 2 to 3. Unfortunately, sample sizes in these studies have been marginal for any reliable conclusions to be madeJ 6 In all studies, sample sizes have been insufficient to allow stratification by more than a few maternal Or paternal variables, and all combinations of drug therapy or convulsive disorders have been analyzed together. Consideration of the dosage and timing of drug exposures has not been specified. Epidemiologic studies have thus far failed to answer the question: Is the risk for congenital abnormalities in the offspring of treated epileptic women related to drug therapy or to the underlying convulsive disorder or genetic factors? Two areas of study suggest that a portion of the increased risk may be attributable to drug therapy. As illustrated in the Table, in retrospective studies the frequency of abnormality in the offspring of treated epileptic women is consistently greater than in the offspring of