小儿难治性癫痫病灶定位和发病机制的研究

发布时间：2018-05-30 18:44

本文选题：正电子发射计算机断层扫描 + 动态视频脑电图　；参考：《福建医科大学》2013年硕士论文

【摘要】：[目的] 运用正电子发射计算机断层扫描(PET-CT)、动态视频脑电图(VEEG)、颅脑磁共振（MRI）三项检查技术，研究它们在小儿难治性癫痫患者术前定位及术后疗效中的临床意义，探讨PET-CT、VEEG和MRI三项检查综合评价小儿难治性vr痫患者病灶定位及术后预后的临床价值，从而选择最佳的检查方法；观察r-氨基丁酸(r-GABA)在难治性癫痫患儿脑组织中的表达情况,探讨其在难治性癫痫发病机制中的作用。 [方法] 第一部分：对我院2011年8月至2012年3月期间神经外科癫痫研究治疗中心诊断为难治性癫痫的30例患儿的临床影像学资料进行收集，同时将手术切除的脑组织标本进行光学显微镜观察，并且进行病理学诊断。对行VEEG和MRI两项检查的，结果与其病理结果进行比较，术后随访半年，观察术后疗效；对行PET-CT、VEEG、MRI三项检查的，，结果与其病理结果进行比较，术后随访半年，观察术后疗效。将采取两项检查的术后疗效和采取三项检查的术后疗效进行比较。第二部分：15例患儿均来自我院神经外科癫痫研究治疗中心，经临床症状学及VEEG、MRI、PET/CT检查等综合评估的方法，确定致痫灶并行神经功能外科学手术切除致痫灶治疗,将手术切除的脑组织颞叶皮层标本(实验组)和8例非癫痫病史的患儿的手术切除的正常脑组织标本（脑肿瘤4例，脑血肿4例）(对照组)进行比较。免疫组织化学染色方法采用pv-9000法（二步法免疫组化检测试剂）标记两组脑组织标本中的γ－氨基丁酸(γ-GABA)能神经元,于光镜(×200)倍视野下计数,对两组γ－GABA能神经元个数进行统计,同时观察实验组颞叶皮层光镜(×100,×200)下存在的病理学改变。采用SPSS13.0统计软件包对数据进行处理,实验组和对照组采用两独立样本的t检验方法,以P 0.05为差异有统计学意义。 [结果] 第一部分：30例患儿中,有24例患儿行PET/CT、VEEG和MRI三项检查，三者病灶定位一致14例,手术有效率为91.5%；有6例患儿行VEEG和MRI两项检查，两者病灶定位一致4例，手术有效率为66.7%。第二部分：实验组与对照组比较,实验组阳性细胞个数为116.04±30.58，对照组阳性细胞个数191.78±79.65，实验组γ－GABA能神经元表达水平较对照组下降,显著性差异具有统计学意义(P 0.05)。实验组颞叶皮层可见神经元丢失、变性及胶质细胞增生、肥大、突起增多，颞叶皮质各层中GAD67免疫组化染色结果，可见皮质细胞层次结构紊乱，皮质结构发育不良伴不成熟神经元，血管周围淋巴细胞浸润，皮层水肿伴小软化灶形成等病理学改变。 [结论] 1.本研究显示各种检查技术都是从癫痫的不同角度进行研究，各有优劣，所以不能仅凭一种技术给予明确的定位，应根据临床表现，发作类型，神经精神心理评估等各方面有针对地选作各项检查。PET/CT、VEEG、MRI三项检查技术综合起来对术前致痫灶的准确定位有较大的指导意义。对术前确定手术方案有较好的作用。手术治疗癫痫效果满意。 2.本研究显示胶质细胞形态学的改变，神经元细胞数目、形态的变化最有可能是小儿难治性癫痫的发病机制之一。 3.同时病理学还可观察到皮质发育不良、皮质结构的紊乱、噬神经、血管周围神经浸润等多种病理学改变，这些病理学的改变都有可能是小儿难治性癫痫的发病机制之一。 4.免疫组织化学染色显示实验组和对照组神经元胞浆中均可见棕褐色阳性细胞,表明均有r-氨基丁酸能神经元表达,实验组数量明显低于对照组。 5.实验组数量明显低于对照组,推测其可能与难治性癫痫的发生存在一定的关系。
[Abstract]:Purpose of the project

The clinical significance of positron emission computed tomography ( PET - CT ) , dynamic video electroencephalogram ( VEEG ) and brain magnetic resonance ( MRI ) in children with refractory epilepsy was studied .
To investigate the expression of r - aminobutyric acid ( r - aminobutyric acid ) in brain tissue of children with refractory epilepsy and to investigate its role in the pathogenesis of intractable epilepsy .

Methodology

In the first part , the clinical imaging data of 30 children with refractory epilepsy were collected from August 2011 to March 2012 in our hospital , meanwhile , the brain tissue samples were examined by optical microscope and pathology diagnosis was performed . The results were compared with the pathological results of VEEG and MRI .
The results of three examinations of PET - CT , VEEG and MRI were compared with the pathological results , and the postoperative follow - up period was half a year after operation . The results of two examinations were compared with those of three examinations .

In the second part : 15 cases of children were treated by the comprehensive evaluation method of neurological surgery epilepsy in our hospital , clinical symptoms and VEEG , MRI , PET / CT examination and so on . The pathological changes of the two groups of 纬 - aminobutyric acid ( 纬 - GABA ) neurons were determined by using the method of pv - 9000 ( two - step immunohistochemical detection reagent ) .

The result is not valid .

The first part : Of the 30 cases , 24 children were examined with PET / CT , VEEG and MRI . The three lesions were consistent in 14 cases and the effective rate was 91.5 % .
There were 6 cases with VEEG and MRI examination . The lesions were consistent in 4 cases and the effective rate was 66.7 % .

The second part : Compared with the control group , the number of positive cells in the experimental group was 116 . 04 卤 30 . 58 , the number of positive cells in the control group was 191 . 78 卤 79.65 , the expression level of 纬 - GABA - ergic neurons in the experimental group was lower than that of the control group , and the significant difference was statistically significant ( P 0.05 ) . The expression of GAD67 was found in the cortex of temporal lobe of experimental group , degeneration and glial cell hyperplasia , hypertrophy , increased protrusion and GAD67 immunohistochemical staining in each layer of temporal lobe cortex . The pathological changes of cortical cell structure disorder , cortical dysplasia with immature neurons , peripheral lymphocyte infiltration , cortical edema and formation of small softening range were seen .

Conclusion

1 . The study shows that all kinds of examination techniques have been studied from different angles of epilepsy . Therefore , it can not only be clearly positioned by one technique , but it should be selected according to the clinical manifestation , type of attack , neuropsychological assessment and so on . PET / CT , VEEG and MRI have a great guiding significance for the accurate positioning of the pre - operative epileptogenic foci .

2 . This study shows that the changes of glial cell morphology , the number of neurons and the change of morphology are most likely to be one of the pathogenesis of intractable epilepsy in children .

3 . At the same time , we can observe the pathological changes of cortical dysplasia , cortical structure disturbance , tophagy and peripheral nerve infiltration , which may be one of the pathogenesis of intractable epilepsy in children .

4 . Immunohistochemical staining showed that brown - brown positive cells were found in the cytoplasm of neurons in the experimental group and the control group , indicating that the r - aminobutyric acid was able to express the neurons , and the number of experimental groups was significantly lower than that of the control group .

5 . The number of experimental groups was significantly lower than that of the control group , and it was speculated that it might be related to the occurrence of intractable epilepsy .
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R742.1

【共引文献】