癫痫发作间期脑血流灌注功能与脑组织损伤程度相关性研究

Correlation between regional cerebral blood flow and degree of brain tissue injury of interictal epileptic activity in patients with epilepsy

目的探讨癫痫患者抗癫痫药物治疗期间不同疗效状态下，发作间期致痫灶局部血流灌注和脑细胞功能低下与脑组织损伤程度的相关性。方法按随机数字表法随机选择48例癫痫发作间期患者，采用双抗体夹心ELISA法测血清S-10013蛋白的水平，SPECT脑血流显像测定局部脑血流量，并与30例对照者进行比较。采用SPSS11．0软件进行统计学分析，两样本均数之间行t检验，多样本比较采用方差分析，两变量间相关性分析用线性相关分析法进行。结果癫痫发作间期患者血清S-10013蛋白水平（0．572±0．163）μg/L，高于对照组（0．218±0．134）μg/L，差异有统计学意义（t=9．96，P〈0．01）。根据癫痫控制标准，患者中控制20例，显效和有效18例，无效10例；3组s．100t3蛋白水平和局部脑血流（rCBF，％）分别为（0．443±0．083）μg/L和（0．035±0．038）％，（0．585±0．108）μg/L和（0．187±0．075）％，（0．809±0．056）μg/L和（0．337±0．060）％，无效组与其他两组比较，S-10013蛋白水平与rCBF的变化均有统计学意义，其余两组比较差异亦有统计学意义（F=56．740，92．316，P〈0．01）。癫痫患者血清S-100p蛋白水平、rCBF下降百分率呈高度正相关（r=0．887，P〈0．01）。结论SPECT脑血流灌注显像联合检测血清S-100β蛋白水平，可对癫痫致痫灶进行定位，并评价癫痫所致的脑组织损伤。S-100β蛋白水平可作为抗癫痫药物治疗癫痫疗效的监测指标。

Objective To explore the correlation between the change of regional cerebral blood flow （rCBF） and brain tissue injury from interictal epileptic activity in patients with epilepsy. Methods Fortyeight patients with epilepsy and 30 healthy persons were included in the styudy from which the serum S- 10013 protein levels were determined by double antibody sandwich ELISA method. SPECT rCBF imaging was performed in all patients. The visal and semi-quantitative analyses were used to analyze the epileptic foci. SPSS 11.0 was applied for variance and linear correlation analyses. Results Serum S-100β in patients with interictal epileptic activity was significantly higher than that in control group （ （0.572 ±0. 163 ） μg/L vs （0.218 ± 0.134） μg/L, t = 9.96, P 〈 0.01 ）. According to epilepsy control criteria, 20 cases achieved complete control （CC）, 18 cases acheived partial control （PR）. However, 10 cases got no improvement, whose serum S-100β protein （ （0. 809 ± 0. 056） μg/L） and the percentage change of rCBF （ （0. 337 ± 0. 060）% ） were significantly higher than those ofCC （ （0.443±0.083） μg/L, （0.035 ±0.038）% ） and those of PC （ （0.585 ± 0. 108） μg/L, （0. 187 ± 0.075 ） % ）, F = 56. 740, 92. 316, P 〈 0.01. There were high correlation between serum S-100β and the percentage change of rCBF in epilepsy patients （r =0. 887, P〈0.01）. Conclusion Serum S-100β protein assay combined with rCBF on SPECT imaging can make semi-quantitative diagnosis of epilepsy and help evaluate the brain damage from interictal epileptic activity.