不同癫痫类型患儿发作后血清褪黑素、催乳素水平的变化及意义

Change and Significance of Serum Melatonin and Prolactin Levels after the Onset of Different Types of Epileptic Seizure in Children

目的探讨不同发作类型的癫痫患儿发作后血清褪黑素(MEL)和催乳素(PRL)水平的变化及临床意义。方法本研究共纳入120例儿童,其中癫痫组(EP组)71例,分全身强直阵挛发作组(GTCS组)31例、复杂部分发作组(CPS组)18例和简单部分发作组(SPS组)22例;非痫性发作组(NEP组)23例;对照组为上呼吸道感染发热无惊厥患儿26例。采用酶联免疫吸附法(ELISA)和双抗体夹心电化学发光法分别测定各组患儿血清MEL、PRL水平。结果 EP患儿血清MEL中位数水平为12.16ng/L,均显著低于NEP组(24.28ng/L)和对照组(26.10ng/L)(P<0.01);而EP患儿血清PRL中位数水平为24.80μg/L,均显著高于NEP组(10.07μg/L)和对照组(9.41μg/L)(P<0.01);NEP组和对照组血清MEL、PRL水平均无显著性差异(P>0.05)。EP组患儿痫性发作后2h血清MEL、PRL水平的关系存显著负相关(r=0.624,P<0.001)。血PRL水平对痫性发作诊断敏感性和特异性分别为56.34%和93.02%。结论癫痫患儿发作后2h血清MEL水平降低,而血清PRL水平上升,尤其以GTCS和CPS为著,提示两者可能与癫痫发病机制有关。早期联合检测可能是临床诊断痫性发作困难病例的一种辅助检查手段。

Objective To observe the changes of serum melatonin（MEL） and prolactin（PRL） levels after the onset of epilepsy （EP） in children, and to study the relationship between them and epilepsy. Methods The study included 120 children met standard, seventyone children with EP（ GTCS group had thirtyone children with generalized tonic- clonic seizures type, CPS group bad eighteen children with complex partial seizures type and SPS group had twenty - two children with simple partial seizures type） , twenty - three children with non- epilepsy onset（ NEP group） and twenty -six upper respiratory infections children with fever and no seizure （Control group）. Serum MEL and PRL levels were measured within two hours after onset of their illness. Serum MEL and PRL were measured by enzyme - linked immunosorbent assay （ELISA） and Electrochemiluminescence double antibody sandwich method respectively. Results The median serum MEL levels of EP group （12. 16μg/L） was significantly lower than the NEP group （24.28ng,/L） and control group （26.10ng/L） （P 〈0.01） and the median serum PRL levels （24.80μ g/L） compared with the NEP group （10.07μ g/L） and control group （9.41μg/L） increased significantly （P 〈0.01 ）. But the median serum MEL, PRL levels between NEP and control groups were not significantly different （P 〉 0.05 ）. There was a a significant negative correlation （r = O. 624, P 〈 0. 001 ） between serum MEL, PRL level in EP group. The diagnostic sensitivity and specificity of the serum PRL level to epileptic seizure were 56.34% and 93.02% respectively, Conclusion The serum MEL increased in 2h after the onset of epilepsy in children, but the serum PRL level decreased, particularly in the GTCS and CPS as forward, which shows they may be related to the pathogenesis of epilepsy. Earlily combined detection of them may be a valuable method of auxiliary laboratory tests to difficult clinical diagnosis cases of epileptic seizures.