脑胶质瘤患者术后脑脊液谷氨酸与继发性癫痫发作的关系

Relationship between postoperative cerebrospinal fluid glutamate and secondary seizures in patients with glioma

目的研究脑脊液谷氨酸水平与脑胶质瘤患者术后继发性癫痫发作的相关性。方法收集190例脑胶质瘤患者外科手术后1个月内的脑脊液标本,根据患者术后是否有继发性癫痫发作将其分成为无癫痫发作组(n=117)和有癫痫发作组(n=73);使用高效液相层析法检测并比较2组患者脑脊液中谷氨酸的水平。结果 35%的胶质瘤患者术后仍有癫痫发作,其中96%的患者术前有癫痫发作。与胶质瘤术后继发癫痫发作风险相关的独立临床因素包括:术前有癫痫发作、年龄较轻、肿瘤位于颞叶和肿瘤中含少突胶质细胞成分。术后有癫痫发作的胶质瘤患者脑脊液中谷氨酸水平明显高于无癫痫发作组(P<0.05)。Logistic回归分析发现:脑脊液中谷氨酸浓度的增加,年龄较轻、肿瘤位于颞叶和肿瘤中含少突胶质细胞成分,可以作为胶质瘤术后继发癫痫发作的独立预测因子。结论脑脊液谷氨酸水平的增加与脑胶质瘤患者术后继发癫痫发作的风险密切相关,脑脊液谷氨酸水平或可成为预测胶质瘤术后癫痫发生的潜在指标。

Objective To study the correlation between cerebrospinal fluid glutamate levels and postoperative secondary seizures in patients with glioma.Methods Cerebrospinal fluid specimens were collected from 190 patients with glioma within 1 month after surgery,and were classified into non seizure group(n=117)and seizure group(n=73)according to whether there was secondary seizure after surgery;High-performance liquid chromatography was used to detect and compare the levels of glutamate in the cerebrospinal fluid of the two groups of patients.Results 35% of glioma patients still have seizures after surgery,and 96% of them have seizures before surgery.Independent clinical factors associated with the risk of secondary seizures after glioma surgery include:preoperative seizures,younger age,tumors in temporal lobe and tumors containing oligodendrocyte components.The level of glutamate in the cerebrospinal fluid of patients with glioma after seizure was significantly higher than that in the non seizure group(P<0.05).Logistic regression analysis found that the increase of glutamate concentration in cerebrospinal fluid,younger age,tumor in the temporal lobe and tumor containing oligodendrocyte components,can be used as an independent predictor of secondary seizure after glioma surgery.Conclusion The increase in cerebrospinal fluid glutamate levels is closely related to the risk of postoperative seizures in patients with gliomas.Cerebrospinal fluid glutamate levels may be a potential predictor of postoperative epileptic seizures in gliomas.