幼年热惊厥对内侧颞叶癫痫脑结构影响的磁共振成像形态学分析

Magnetic resonance imaging morphological study of the effects of juvenile febrile convulsions on the brain structure of medial temporal lobe epilepsy

目的探究幼年热惊厥对内侧颞叶癫痫(mTLE)灰质体积(GMV)的影响及其与病程的相关性。方法采用回顾性研究方法收集41例有幼年热惊厥病史的mTLE患者(mTLE-FC)、42例无原始促发因素的mTLE患者(mTLE-noIPI)以及42例年龄、性别相匹配的正常对照被试。对所有受试者进行高分辨率T1加权成像(T1WI)全脑磁共振成像扫描。采用基于体素的形态学测量方法获得灰质体积(GMV)脑图,并比较3组受试者GMV差异(P<0.01,高斯随机场理论校正),最后使用Spearmen秩相关分析探讨mTLE GMV变化与病程的相关性。结果相比于正常对照被试,各mTLE患者表现出广泛GMV降低,主要表现在致痫灶侧海马、丘脑、颞叶及双侧小脑。mTLE-FC患者致痫灶侧海马、杏仁核、颞下回及对侧海马、海马旁回、内扣带回GMV减少较mTLE-noIPI患者更明显。同时,mTLE-FC患者致痫灶侧杏仁核及海马GMV与病程呈显著负相关(r=-0.381,P=0.014),而mTLE-noIPI患者则无下降趋势(r=0.081,P=0.611),mTLE-FC患者致痫灶侧杏仁核及海马萎缩趋势显著大于mTLE-noIPI患者(P=0.029,置换检验)。结论mTLE患者存在以海马为主的双侧大脑半球广泛灰质结构损伤;既往有幼年热惊厥病史的mTLE患者脑损害更加广泛和严重,且随病程进行性加重的趋势更加明显,提示幼年热惊厥相关mTLE可能具有不同的病理生理机制。

Objective To investigate the effect of febrile convulsions on gray matter volume(GMV)in medial temporal lobe epilepsy(mTLE)and its correlation with disease duration.Methods A retrospective study was conducted to collect 41 mTLE patients with a history of febrile convulsions(mTLE-FC),42 mTLE patients with no initial precipitating injury(mTLE-noIPI),and 42 normal and age and sex matched normal controls.High-resolution T1-weighted(T1WI)whole brain MR scans were performed on all subjects.Voxel-based morphometry were used to obtain GMV brain maps,and the GMV differences between the three groups of subjects were compared(P<0.01,GRF corrected).Finally,Spearmen rank correlation analysis was used to explore the correlation between GMV changes and the course of disease.Results Compared with the normal control subjects,each mTLE group showed extensive GMV reduction,mainly in the affected hippocampus,thalamus,temporal lobe,and bilateral cerebellum.Further analysis found that mTLE-FC group had more significant reductions in GMV than the mTLE-noIPI group in the affected hippocampus,amygdala,inferior temporal gyrus,contralateral hippocampus,para hippocampus,and inner cingulate gyrus.At the same time,the affected amygdala and hippocampal GMV in the mTLE-FC group was significantly negatively related to the course of disease(r=-0.381,P=0.014),while the mTLE-noIPI group had no downward trend(r=0.081,P=0.611).The atrophic trend of the affected amygdala and hippocampus in patients with mTLE-FC was significantly greater than that in patients with mTLE-noIPI(P=0.029,permutation test).Conclusions There is extensive damage to the gray matter structure of bilateral cerebral hemispheres,mainly in the hippocampus,in mTLE patients.The brain damage of mTLE patients with a history of juvenile fever convulsions is more extensive and serious,and the trend of progressive exacerbation with the course of the disease is more obvious,suggesting mTLE associated with juvenile fever convulsions may have different pathophysiological mechanisms.