不同类型脑性瘫痪患儿脑脊液氨基酸变化

Levels of amino acids in cerebral spinal fluid in children with cerebral palsy

目的目前对于脑瘫与脑内神经递质的关系研究很少,该研究通过测定不同类型脑瘫患儿脑脊液中谷氨酸、天冬氨酸、γ-氨基丁酸的含量,以了解不同类型脑瘫患儿脑脊液中氨基酸变化。方法选取13例痉挛型脑瘫患儿、14例徐动型脑瘫患儿及同期已排除神经系统疾病和感染性疾病的10例手术患儿,分别设为痉挛组、徐动组和对照组。每1例均于手术麻醉前自腰椎3,4椎间隙穿刺取无血污脑脊液2 mL,取上清液用高效液相色谱-荧光法测定谷氨酸、天冬氨酸、γ-氨基丁酸含量。结果①对照组脑脊液中γ-氨基丁酸、天冬氨酸、谷氨酸分别为13.04±2.19μmol/L,10.21±0.45μmol/L,8.41±2.26μmol/L;与对照组比较,痉挛型脑瘫患儿脑脊液中γ-氨基丁酸显著降低为8.02±2.03μmol/L,(P<0.01),谷氨酸、天冬氨酸显著增高为20.99±8.15μmol/L、13.53±3.93μmol/L(P<0.05,P<0.01);徐动型脑瘫脑脊液中γ-氨基丁酸显著降低为10.01±2.68μmol/L(P<0.01),谷氨酸、天冬氨酸显著增高为28.77±17.62μmol/L,14.02±2.88μmol/L(P<0.01)。痉挛型脑瘫与徐动型脑瘫比较,痉挛型脑瘫患儿脑脊液中γ-氨基丁酸显著降低,而谷氨酸、天冬氨酸含量两者差异无显著性(P>0.05)。②线性相关分析发现痉挛型脑瘫患儿脑脊液中谷氨酸的水平与肌张力呈等级正相关;γ-氨基丁酸和天冬氨酸的水平与肌张力无相关性。结论脑瘫患者脑脊液中兴奋性氨基酸含量较正常儿童增高,抑制性氨基酸含量较正常儿童降低,且不同类型脑脊液中氨基酸含量存在差异,氨基酸水平的改变可能是脑瘫患儿的病理改变的基础之一。

Objective To study the changes of amino acids in cerebral spinal fluid （CSF） in children with spastic or athetotic cerebral palsy （CP） by examining CSF levels of glutamic acid （Glu）, gamma-aminobutyric acid （GABA） and aspartate （ASP）. Methods CSF samples were obtained from 13 children with spastic CP, from 14 children with athetotic CP, and from 10 children without central nervous system and infectious diseases （control group）. CSF levels of Glu, GABA and ASP were determined by high-performance liquid chromatography. Results CSF levels of GABA, ASP and Glu in the control group were 13.04±2. 19, 10.21 ± 0.45 and 8.41 ± 2.26 μmol/L, respectively. Compared with the control group, CSF GABA levels in the spastic and the athetotic CP groups （ 8.02 ± 2.03 and 10.01 ± 2.68 μmol/L respectively） significantly decreased （ P 〈 0.01 ）, whereas CSF levels of Glu （20.99±8. 15 and 28.77 ± 17.62 μmol/L respectively） and Asp （13.53 ± 3.93 and 14.02 ± 2.88 μmol/L respectively） in the spastic and the athetotic CP groups significantly increased （P 〈 0.01 ）. There were statistical differences in the GABA level between the spastic and the athetotic CP groups （P 〈 0.05）. In children with spastic CP, CSF Glu level was positively correlated to muscle tension. Conclusions CSF excitatory amino acid levels increased, while CSF inhibitory amino acid levels decreased in children with CP. There were differences for CSF amino acid levels in different types of CP. The changes of amino acid levels may contribute to the pathogenesis of CP.