临床下痫样放电对癫痫患者认知功能及胰岛素样生长因子1水平的影响

Cognitive function and insulin-like growth factor-1 levels in patients with subclicinal epileptiform discharges

目的观察临床下痫样放电的癫痫患者认知功能、血清胰岛素样生长因子1(IGF-1)浓度及其临床意义。方法以全身强直阵挛性发作为临床表现的特发性癫痫患者86例,无临床发作均超过3个月,分为临床下痫样放电组(47例)以及脑电图正常组(39例)。选取性别、年龄与癫痫患者相匹配的健康体检者30例作为对照组。采用酶联免疫吸附试验(ELISA)测定血清IGF-1的浓度。采用连线测验、数字符号转换测验、语言流畅性测验、数字广度测验等神经心理量表,分别检测各组心理运动速度、注意力、语言、工作记忆等认知功能。用t检验或方差分析统计各计量资料。结果临床下痫样放电组IGF-1浓度[(291±99.58)ng/ml]明显高于脑电图正常组[(189±75.63)ng/ml,t=13.29,P<0.01];脑电图正常组和对照组[(176±65.75)ng/ml]间IGF-1含量差异无统计学意义(P>0.05)。临床下痫样放电组连线A、B耗时均高于脑电图正常组,数字符号、语言流畅性及数字广度评分均低于脑电图正常组,差异有统计学意义(t值分别为4.12、3.18、3.09、4.15、5.01,均P<0.05)。临床下痫样放电组IGF-1含量与棘波指数、连线A、B耗时呈显著正相关,与数字符号分、语言流畅性分、数字广度分呈显著负相关(P<0.05或0.01)。结论临床下痫样放电患者血清IGF-1表达上调,提示临床下痫样放电会导致神经损伤,并启动神经保护机制。针对临床下痫样放电应采取适当的干预措施。

Objective To investigate the cognitive function and serum levels of insulin -like growth factor-1（IGF-1）in patients with subclicinal epileptiform discharges and clinical significance .Mtehods The generalized tonic-clonic seizures as the clinical manifestations ,86 patients of idiopathic epilepsy who were free of clinical seizures more than three months ,included 47 cases of epileptiform discharges and 39 normal cases demonstrated by video-eletroencephalogram（EEG）.30 healthy volunteers matched with age and sex to the epilepsy group served as control group .Serum IGF-1 levels were determined by using enzgmelinked immunosorbent assay （ ELISA ） .The neuropsychological tests including trail making test , digit symbol test , verbal fluency test and digit span test were used to detect mental and motor speed ,attention,language and working memory respectively .t test or analysis of variance were used to compare each measurement data . Results Serum IGF-1 levels increased significantly in the subclicinal epileptiform discharges group [ （291 ± 99.58）ng/ml]compared with the normal group [（189 ±75.63）ng/ml,t=13.29,P〈0.01].There were no statistical difference in IGF-1 levels between the normal group and control group [（176 ±65.75）ng/ml]. The subclicinal epileptiform discharges group consume more time to accomplish the trail making test A and B,and lower scores in digit symbol test, verbal fluency test and digit span test than the normal group （ t values were4.12,3.18,3.09, 4.15,5.01,respectively,all P〈0.05）.Further more,serum IGF-1 levels negatively correlated with digit symbol test,verbal fluency test and digit span test（P〈0.05 or P〈0.01）. Conclusion Serum IGF-1 levels increases after subclicinal epilepti form discharges , suggesting that＆amp;nbsp;subclicinal epileptiform discharges might cause brain damage and neuroprotection starting .Effective interventionalmeasures should be taken in these patients .