本文關(guān)鍵詞： 癲癇 磁共振成像 體素 形態(tài)學(xué)　出處：《醫(yī)學(xué)研究生學(xué)報(bào)》2017年05期 　論文類型：期刊論文

【摘要】：目的目前尚無左乙拉西坦(LEV)對兒童良性癲癇(BECTS)腦灰質(zhì)重塑的研究。文中旨在通過基于體素的MRI形態(tài)學(xué)探討LEV對伴中央顳區(qū)棘波的BECTS腦灰質(zhì)結(jié)構(gòu)的影響,評價(jià)LEV對BECTS的腦作用機(jī)制。方法連續(xù)納入2014年1月至2016年9月在南京市兒童醫(yī)院及南京軍區(qū)南京總醫(yī)院神經(jīng)內(nèi)科就診的24例服用LEV的BECTS患兒(LEV組)和24例未經(jīng)治療的BECTS患兒(未服藥組)。另納入24名正常兒童(正常組)均在3T MRI儀下行三維T1加權(quán)成像,采用MRI形態(tài)學(xué)的方法計(jì)算受試者腦灰質(zhì)體積,比較各組的灰質(zhì)體積差異,并與癲癇病程、起病年齡及用藥時(shí)間等臨床指標(biāo)進(jìn)行相關(guān)分析。結(jié)果與正常組比較,未服藥組的雙側(cè)丘腦灰質(zhì)體積減少,雙側(cè)Rolandic區(qū)、前島葉/島蓋部/三角部、左側(cè)輔助運(yùn)動區(qū)、中央旁小葉、中央前回、額上回和右側(cè)額中回灰質(zhì)體積增加;而LEV組雙側(cè)Rolandic區(qū)、額下回島蓋部及左側(cè)輔助運(yùn)動區(qū)灰質(zhì)體積減少。與未服藥組比較,LEV組的雙側(cè)輔助運(yùn)動區(qū)、左側(cè)中央旁小葉、中央前回、雙側(cè)前島葉/島蓋部/三角部、左側(cè)額上回及右側(cè)額中回的灰質(zhì)體積減少。左側(cè)前島葉/島蓋部的灰質(zhì)體積分別與未服藥組、LEV組呈正相關(guān)、負(fù)相關(guān)(r=0.394、-0.527,P0.05)。LEV組的左側(cè)前島葉/島蓋部的灰質(zhì)體積與其用藥時(shí)間呈負(fù)相關(guān)(r=-0.527,P0.01)。結(jié)論BECTS主要表現(xiàn)為丘腦灰質(zhì)結(jié)構(gòu)損害及癲癇相關(guān)皮層區(qū)域刺激性結(jié)構(gòu)異常,LEV的抗癲癇作用可以重塑癲癇相關(guān)皮層區(qū)域及其臨床癥狀相關(guān)腦區(qū)的灰質(zhì)結(jié)構(gòu)。
[Abstract]:Objective at present, there is no levoethoxetam (Levo) in the treatment of benign epilepsy in children (BECTS). The aim of this study was to investigate the effect of LEV on the gray matter structure of BECTS with central temporal spikes by means of voxel based MRI morphology. Methods from January 2014 to September 2016, 24 patients who were admitted to Nanjing Children's Hospital and Department of Neurology, Nanjing General Hospital of Nanjing military region received L. BECTS of EV (. LEV group) and 24 untreated BECTS children (no medication group), and 24 normal children (normal group) were all performed 3D T 1 weighted imaging on 3T MRI instrument. The gray matter volume of the subjects was calculated by MRI morphology, and the difference of gray matter volume in each group was compared with that of epilepsy. Results compared with the normal group, the bilateral thalamic gray matter volume decreased, bilateral Rolandic area, anterior insular lobe / tegmental part / triangle in the control group were compared with those in the control group. The volume of gray matter increased in the left auxiliary motor area, paracentral lobules, precentral gyrus, superior frontal gyrus and right middle frontal gyrus. However, the volume of gray matter in the bilateral Rolandic area, the inferior frontal gyrus and the left auxiliary motor area in the LEV group was decreased. Compared with the control group, the bilateral auxiliary motor area and the left central paracentral lobules in the LEV group were significantly lower than those in the control group. The volume of gray matter in precentral gyrus, bilateral anterior insular lobe / cap / triangle, left superior frontal gyrus and right middle frontal gyrus decreased. There was a negative correlation between the volume of gray matter in the left anterior insular / cap of the left island and the time of medication in the 0.394- 0.527 P0.05. LEV group, and there was a negative correlation between the volume of gray matter in the left anterior islet / cap and the drug use time. Conclusion BECTS is mainly characterized by the damage of gray matter structure of thalamus and the abnormal irritative structure of epileptic-related cortical region. The antiepileptic effect of LEV can reshape the gray matter structure of epileptogenic cortical region and clinical symptom related brain area.
【作者單位】： 南方醫(yī)科大學(xué)金陵醫(yī)院(南京總醫(yī)院)醫(yī)學(xué)影像科;南方醫(yī)科大學(xué)金陵醫(yī)院(南京總醫(yī)院)神經(jīng)內(nèi)科;南京市兒童醫(yī)院神經(jīng)內(nèi)科;
【基金】：國家自然科學(xué)基金(81271553,81422022)
【分類號】：R742.1;R445.2
【正文快照】： 0引言伴中央顳區(qū)棘波的兒童良性癲癇(benign child-hood epilepsy with centro-temporal spikes,BECTS)是一種最常見的兒童癲癇綜合征,發(fā)病高峰為7~10歲[1]。既往多認(rèn)為BECTS是一種良性的癲癇,但近來研究表明其神經(jīng)心理方面的預(yù)后卻并不樂觀,BECTS可有記憶、語言障礙和執(zhí)行控

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