难治性癫痫致痫灶中少突胶质细胞改变的观察研究

The change of oligodendrocyte in the epileptogenic zone from patients with intractable epilepsy

目的研究难治性癫痫(IE)患者致痫灶脑组织中少突胶质细胞(OL)的变化。方法选择2011-06-2012-06在贵州省人民医院神经外科行致痫灶切除的30例IE患者,术后随访至少6个月,了解患者术后癫痫发作的控制情况;用HE染色、LFB染色方法观察致痫灶脑组织病理改变,用免疫组化方法检测髓鞘碱性蛋白(MBP)、O4、血小板源性生长因子α受体(PDGFαR)和A2B5在致痫灶中表达情况,以观察不同时期OL的变化,并与健康对照组脑组织中MBP、O4、PDGFαR、A2B5表达情况进行比较。结果 (1)术后5例失访,实际随访25例患者。术后效果按Engel标准分类,Ⅰ级占14/25,Ⅱ级占8/25,Ⅲ级占6/25,Ⅳ级占2/25;(2)HE染色结果显示IE患者致痫灶中神经细胞层次结构紊乱、气球样变,胶质细胞增生;(3)LFB染色结果显示:与对照组比较,IE组中脑白质髓鞘脱失明显,脱髓鞘评分增加〔(1.9±0.875)vs.(0.4±0.286)(P<0.01)〕;(4)免疫组化结果提示,IE组与对照组比较MBP阳性纤维〔(4.76±0.52)vs.(6.32±1.45)(P<0.05)〕和O4阳性细胞〔(9.62±3.05)vs.(18.02±6.78)(P<0.01)〕减少,PDGFαR阳性细胞〔(10.42±5.70)vs.(1.61±1.14)(P<0.01)〕和A2B5阳性细胞〔(15.10±7.45)vs.(7.20±1.30)(P<0.05)〕增多。结论在IE致痫灶中OL发育各阶段的动态变化可能与IE发病有关。

Objective To investigate the change of oligodendrocyte （OL） in the epileptogenic zone from patients with intractable epilepsy （IE）.Methods Choose the brain tissue of 30 patients with IE who were operated ＇epileptogenic zone resection＇ from June 2011 to June 2012 in the Department of Neurosurgery of the People＇ s Hospital of Guizhou Province.We followed up the patients after operation,to acquire the postoperative seizure control status.We observed the pathological change with HE and Luxol fast blue （LFB）staining,detected the expression of MBP,A2BS,O4,and PDGFαR by immunohistochemisty to study the change of OL in different stage and compared with the control group.Results （1） Five cases were lost.According to the Engel standard,the postoperative follow-up results showed that 14/25 of them were in grade Ⅰ,8/25 in gradeⅡ,6/25 in grade Ⅲ,and 2/25 in grade Ⅳ; （2） HE staining detected the disturbance of nervous cell structure,the balloon degeneration,and the hyperplasia of gliocytes in the IE group; （3） LFB staining showed that the obvious demyelinating in white matter of the IE patients,and there were significant difference in the scores of demyelinating of the two groups [（1.9-±-0.875） vs.（0.4±0.286） （P〈0.01）]; （4） Compared with the control group,immunohistochemisty staining showed that the MBP positive fibers were decreased in the IE group [（4.76-±-0.52） vs.（6.32-±-1.45） （P〈0.05）],the O4 positive cells were reduced in the IE group [（9.62±3.05） vs.（18.02±6.78） （P〈0.01）],the PDGFαR positive cells were increased in the IE group [（10.42±5.70） vs.（1.61±1.14） （P〈0.01）],and the A2B5 positive cells were increased in the IE group [（15.10±7.45） vs.（7.20±1.30） （P〈0.05）].Conclusions The dynamic change of OL in epileptogenic zone may have some correlation with IE