A型肉毒毒素对原发性眼睑痉挛中枢感觉传导通路影响的研究

发布时间：2018-08-09 17:18

【摘要】：背景：眼睑痉挛（BSP）是一种局灶型肌张力障碍，以原发性多见。通常认为原发性眼睑痉挛是由于遗传易感因素以及眼的运动感觉输入在中枢神经系统整合功能障碍导致的。A型肉毒毒素（BTX-A）是眼睑痉挛的首选治疗。研究表明BTX-A改善眼睑痉挛运动症状，不仅通过其外周作用，还可能存在一定的中枢作用。但是目前国内外对BTX-A中枢作用的研究较少，并且多为BTX-A对中枢运动神经元的影响。三叉神经体感诱发电位（TSEP）是通过电脉冲刺激三叉神经末梢，在三叉神经感觉传导通路多个神经元聚集区记录诱发电位的波幅，在一定程度上反映口周感觉传导通路功能变化。辅助运动区（SAM）同时接受感觉和运动神经元投射，可以代表部分感觉运动整合的过程。在TSEP中加入代表辅助运动皮层的F5/F6位点，可以在观察感觉通路变化的同时，也观察部分的感觉运动整合过程的改变。目的：将皮层多点记录的三叉神经体感诱发电位应用于眼睑痉挛研究，对比BSP患者与正常受试者三叉神经感觉通路兴奋性变化，及BTX-A注射前后运动症状改善同时，感觉通路兴奋性的改变和感觉运动整合的变化。方法：皮层多点记录的TSEP研究：14例正常对照（I），14例确诊为原发性眼睑痉挛的患者BTX-A注射前（II），，注射后一个月（III），分别行皮层多点记录的TSEP检测，两两比较，分析C(5,6) N13-P19、P19-N30峰间期， N13/P19、N19/N30峰峰幅度测值变化情况，以及F(5,6) N13’-P19’、P19’-N30’峰间期，N13’/P19’、P19’/N30’峰峰幅度变化。结果： BTX-A注射后，BSP患者JRS量表评分显著低于BTX-A注射前，差异有统计学意义（P0.05），14例患者平均BIDS评分为0.73±0.02。皮层多点记录的三叉神经体感诱发电位研究：三组间C(5,6)位点记录，N13-P19、P19-N30峰间期差异无统计学意义（P0.05）。II N13-P19、P19-N30峰峰幅度高于I，差异有统计学意义（P0.05）。II N13/P19、P19/N30峰峰幅度显著高于III，差异有统计学意义（P0.01）。I与III各波峰峰幅度比较，N13-P19、P19-N30峰峰幅度差异无统计学意义（P0.05）；三组间F(5,6)位点记录，N13’-P19’、P19’-N30’峰间期差异无统计学意义（P0.05）。II N13’-P19’、P19’-N30’峰峰幅度高于I，差异有统计学意义（P0.05）。II N13’/P19’、P19’/N30’峰峰幅度显著高于III，差异有统计学意义（P0.01）。I与III各波峰峰幅度比较，N13’-P19’、P19’-N30’峰峰幅度差异无统计学意义（P0.05）。结论： 1、A型肉毒毒素注射治疗可显著改善原发性眼睑痉挛临床症状。 2、A型肉毒毒素注射后，原发性眼睑痉挛患者三叉神经感觉传导通路兴奋性降低。 3、A型肉毒毒素注射后，原发性眼睑痉挛患者皮质下至辅助运动皮层通路兴奋性降低。
[Abstract]:Background: blepharospasm (BSP) is a focal dystonia. It is generally believed that primary blepharospasm is the first choice of treatment for blepharospasm due to genetic susceptibility factors and motor sensory input in the central nervous system due to the dysfunction of the integration of the. A botulinum toxin (BTX-A) is the first treatment of blepharospasm. The study shows that BTX-A improves palpebral spasticity, not only through its peripheral effect, but also by central effect. However, there are few studies on the central role of BTX-A at home and abroad, and most of them are the effects of BTX-A on central motor neurons. Trigeminal somatosensory evoked potentials (TSEP) are recorded by electrical pulse stimulation of trigeminal nerve endings, and the amplitude of evoked potentials is recorded in many neuronal areas of the trigeminal sensory conduction pathway, which to some extent reflects the functional changes of the peroral sensory conduction pathway. Both sensory and motor neuronal projections are accepted in the auxiliary motor region (SAM), which can represent the process of sensory and motor integration. The addition of F5/F6 site which represents the auxiliary motor cortex in TSEP can not only observe the changes of sensory pathway, but also observe the changes of sensory motor integration process. Objective: to compare the excitability of trigeminal nerve sensory pathway in patients with BSP and normal subjects, and the improvement of motor symptoms before and after BTX-A injection by applying the multipoint recorded trigeminal nerve somatosensory evoked potential (SEP) in the study of blepharospasm. Changes in sensory pathway excitability and sensory motor integration. Methods: a TSEP study of cortical multipoint recording was performed in 14 patients with primary blepharospasm diagnosed as a normal control group. The TSEP of multipoint cortical records was detected one month before BTX-A injection with (II), in 14 normal controls, and the results were compared with each other. The variation of the amplitude of C _ (5N _ 6) N _ (13) P _ (19) N _ (19) N _ (30) and N _ (13 / P _ (19) N _ (19) N _ (30) peaks, and the amplitude of F _ (5 ~ (6) N _ (13) ~ (-P _ (19) P _ (19) ~ (-N) ~ (30') P _ (19) ~ (19) N ~ (30') peak were analyzed. Results: the score of JRS scale after BTX-A injection was significantly lower than that before BTX-A injection, and the difference was statistically significant (P0.05). The average BIDS score of 14 patients was 0.73 卤0.02. The study of Trigeminal somatosensory evoked potentials recorded at multiple points in the Cortex: there was no significant difference between the three groups in the interpeak interval of N13-P19P19P19-N30 (P0.05). The amplitude of the peak of P19-N30 was higher than that of I.The difference was statistically significant (P0.05) .II N13P19P19P19N30 peak amplitude was significantly higher than that of IIIs, and the difference was significant (P0.05). There was no significant difference between the peak amplitude of N13-P19 and P19-N30 between III and I (P0.01) I (P0.05). There was no significant difference between the three groups in the interpeak interval between the F _ (5N _ 6) locus and the P _ (19) -N _ (30') (P0.05). II. II, N _ (13) ~ (-P _ (19), P _ (19) -N _ (30) 'was higher than I (P 0.05), the difference was statistically significant (P0.05) .II, N _ (13) P _ (19) P _ (19) P _ (19) P ~ (19) / N _ (30') was significantly higher than that of I (P < 0.05). The difference was statistically significant (P0.01). There was no significant difference between the peak amplitude of N13 ~ + -P19 ~ (19) and P19 ~ (19) -N _ (30') between I and III (P0.05). Conclusion: 1Botulinum toxin A injection can significantly improve the clinical symptoms of primary blepharospasm. The excitability of trigeminal sensory conduction pathway was decreased in patients with primary blepharospasm, and the excitability of subcortical to auxiliary motor cortex was decreased after botulinum toxin type A injection in patients with primary blepharospasm.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R777.1

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