磁共振波谱测定癫痫患儿脑内代谢变化及其临床意义的研究

Changes of cerebral metabolism and their clinical significance in epileptic children: a study of magnetic resonance spectroscopy

目的 了解癫患儿脑内代谢变化的特点。方法 应用Elscint2 .0T超导型磁共振仪 ,对 2 5例癫、5例难治性癫患儿脑内N 乙酰天门冬氨酸 (NAA)、肌酸和磷酸肌酸 (Cr)及含胆碱化合物 (Cho)的浓度进行测定 ,并以 10例非颅内疾病患儿作为对照。结果 癫组致灶内NAA及NAA/ (Cr+Cho)比值明显低于病灶对侧 (P <0 .0 1) ;难治性癫病程越长 ,临床发作次数越频繁 ,NAA/ (Cr+Cho)比值下降越明显 ,且 3例患儿乳酸 (Lac)含量明显升高。结论 神经元损伤或丢失可能是癫共同的病理特征 ;NAA/ (Cr+Cho)比值下降可能与病情程度相平行 ;与磁共振成像相比 ,磁共振波谱更能早期、敏感地反映惊厥后的脑损伤。

Objective To investigate the changes of cerebral metabolism and their significance in epileptic children. Method Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) were performed in 25 children with epilepsy, 5 children with intractable epilepsy and 10 children without intracranial diseases as controls. The concentrations of N acetylaspartate (NAA), creatine (Cr ) and choline (Cho) of brain were measured in all the epileptic children and controls. Results (1) The concentration of NAA and the ratio of NAA/(Cr+Cho) were significantly lower in epileptogenic foci than those in the sites on the opposite side ( P <0.01). (2) The ratio of NAA/(Cr+Cho) was reversely related with the disease course ( P <0.05). (3) There was a positive correlation between the ratio of NAA/(Cr+Cho) and the frequency of seizure in intractable epileptic children. The concentration of lactate (Lac) in brain increased significantly in 3 intractable epileptic children. Conclusions Neuron injury or loss was a common pathogenetic characteristics of epilepsy. The ratio of NAA/ (Cr+Cho), as a marker of neuronal function, paralleled the severity of the epilepsy. MRS compared with MRI might be more sensitive in detecting the brain injury caused by seizures.