颞叶内侧癫痫患者的杏仁核体积与临床研究

发布时间：2019-03-08 09:43

【摘要】：目的探讨颞叶内侧癫痫(mesial temporal lobe epilepsy,mTLE)患侧杏仁核体积与临床特点、病理类型的关系,并进一步探讨手术预后不佳的危险因素。方法收集浙江大学医学院附属第二医院癫痫中心自2013年3月至2016年3月通过临床症状学和视频脑电图诊断为的mTLE患者35例。所有患者接受术前评估,行癫痫专用序列头颅MRI及视频脑电图检查。利用3D磁共振(MRI)感兴趣区域(region of interest,ROI)分析,测量术前MRI双侧杏仁核体积,并计算患侧杏仁核体积指数(amygdala volume index,AVI)。35例患者均接受手术治疗,术后经病理明确病因。手术后根据患者Engel分级结果将手术预后分为疗效理想组(Engel Ⅰ级)和疗效不佳组(Engel Ⅱ级～Ⅳ级)。通过对杏仁核体积的定量研究,将患侧AVI与临床特点、病理类型行相关性分析,并将各因素与手术预后行单因素分析及多因素Logistic回归分析。结果35例患者中,AVI与起病年龄(Pearson相关分析r=-0.389;P = 0.019)及手术年龄(Pearson相关分析r=-0.357;P = 0.032)均呈负相关,而与性别、热性惊厥史、病程、是否继发全面性发作、致痫灶定侧、术前发作频率无显著相关。所有病理结果中,13例(37.1%)为局灶性皮质发育不良(focal cortical dysplasia,FCD),9 例(25.7%)为海马硬化(hippocampal sclerosis,HS),7 例(20.0%)为肿瘤,4例(11.4%)为海绵状血管瘤,2例(5.7%)为非特异性的胶质增生改变,不同病理类型的患侧AVI无显著差异。术后疗效理想的患者有30例(85.7%),病程长是mTLE患者术后疗效不佳的独立危险因素(P0.05)。结论对于mTLE患者,患侧杏仁核大小在术前的定侧定位、病因判断及预后评估中无较大价值。mTLE患者一旦手术指征明确,宜早期手术治疗。
[Abstract]:Objective to investigate the relationship between amygdala volume and clinical features and pathological types in patients with medial temporal lobe epilepsy (mesial temporal lobe epilepsy,mTLE), and to further explore the risk factors of poor prognosis. Methods from March 2013 to March 2016, 35 mTLE patients diagnosed by clinical symptoms and video electroencephalogram were collected from the Epilepsy Center of the second affiliated Hospital of Zhejiang University Medical College. All patients were evaluated before operation, and brain MRI and video electroencephalogram (EEG) were performed. The volume of bilateral amygdaloid nucleus of MRI was measured and the volume index of amygdaloid nucleus (amygdala volume index,AVI) was calculated by 3D magnetic resonance imaging (3D-(MRI) (region of interest,ROI analysis. All 35 patients were treated by surgery, and the volume index of amygdaloid nucleus was calculated. The pathogeny was confirmed by pathology. According to the results of Engel classification, the patients were divided into two groups: the ideal group (Engel grade 鈪，

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