癫痫发作前后局部脑葡萄糖代谢改变与内分泌变化的关系

Relation of local cerebral metabolic rate of glucose to endocrinal fluctuation around seizures

目的探讨癫痫发作前后局部脑葡萄糖代谢改变与内分泌变化之间的关系。方法利用ＲＩＡ法对有单叶病灶的７６例癫痫患者进行发作前后血清生长激素（ＧＨ）、泌乳素（ＰＲＬ）、皮质醇（Ｃｏｒ）测定，同时行发作前后脑１８Ｆ脱氧葡萄糖（ＦＤＧ）ＰＥＴ显像，测定病灶局部大脑ＦＤＧ的代谢率。结果癫痫发作后，癫痫灶局部大脑ＦＤＧ代谢相对发作间期均呈相对高代谢，血清ＰＲＬ、ＧＨ、Ｃｏｒ明显升高。癫痫发作后１５ｍｉｎ，８０３％的病例和６８４％的病例血清Ｃｏｒ达到峰值；发作后３０ｍｉｎ，６５８％的病例血清ＧＨ达到峰值；发作后９０ｍｉｎ，大多数病例血清激素水平下降。癫痫发作后血清ＰＲＬ、ＧＨ、Ｃｏｒ升高幅度与癫痫发作类型、发作间期（ＳＦＩ）长短有明显关系，而与癫痫灶位置和癫痫灶局部脑ＦＤＧ摄取率无关。失神性癫痫发作后，大脑局部ＦＤＧ相对摄取率与其他发作类型间差异均无显著性（Ｐ均＞００５），血清ＰＲＬ、Ｃｏｒ不升高或升高不明显；其他发作类型癫痫发作后，ＰＲＬ、Ｃｏｒ显著升高。但癫痫发作后血清ＧＨ变化未表现出发作类型间的差异。ＳＦＩ越短，癫痫发作前血清激素基础水平越低，其中以ＧＨ和Ｃｏｒ最明显，而癫痫发作后血清激素水平的升高幅度越小。?

Objective To probe into the relation of local cerebral metabolic rate of glucose (LCMRglc) to endocrinal fluctuation around seizures Methods Serum prolactin (PRL), growth hormone (GH) and cortisol levels in 76 epileptic patients with unilobar epileptic focus were determined by radioimmunoassay (RIA) before and after seizures Moreover, the patients were examined by 18 F FDG PET imaging and the LCMRglc of epileptic foci was measured Results FDG metabolic level of epileptic foci right at the attack was relatively higher than that at interictal phase, and the serum PRL, GH and cortisol levels were significant higher after seizures The serum PRL levels in 80 3% patients and the serum cortisol levels in 68 4% patients reached their peaks 15 min after seizure The serum GH levels in 65 8% patients reached peaks at 30 min after seizure The changes of hormone levels corelated signifiantly with the lengths of seizure free intervals (SFI) and with the types of seizures, but the changes of hormone levels were of no relation with the site and LCMRglc of epileptic foci In 6 patients with absentia seizures, no significant increase was observed in LCMRglc (P>0 05), nor in serum PRL and cortisol; the changes of GH were not related with the types of seizures Also, the shorter the SFI was, and the lower the basal hormone levels were, and the less the postictal hormone levels increased especially the levels of GH and cortisol Conclusions The serum PRL, GH, cortisol levels are significantly different before and after seizures, the hormone levels reached their peaks from 15 min to 30 min after seizures The changes of postictal hormone levels are corelated significantly with the types of seizures and length of SFI, but the changes of hormone levels are not related with the site and FDG metabolism of epileptic foci