不同发作类型癫(癎)患儿血清神经元特异性烯醇化酶水平研究

摘要

目的 探讨不同发作类型癫(癎)患儿血清神经元特异性烯醇化酶水平变化与脑损害之间的关系.方法 按照1981年国际抗癫(癎)联盟制定的癫(癎)发作类型分类标准,共明确诊断190例癫(癎)患儿(强直-阵挛发作41例、强直性发作34例、阵挛性发作22例、肌阵挛发作12例、无张力性发作17例、失神发作22例、单纯部分性发作21例及复杂部分性发作21例),于癫(癎)发作72 h内施行长程视频脑电图观察和血清神经元特异性烯醇化酶检测.结果 不同发作类型癫(癎)患儿血清神经元特异性烯醇化酶水平均高于正常对照组(P=0.000),其中以肌阵挛发作组[(32.42±6.62)ng/ml]水平最高,除与强直-阵挛发作组(P=0.062)外,与其他各发作类型之间差异均有统计学意义(P=0.000);而其他各类型之间差异无统计学意义(均P＞0.05).秩相关分析显示,癫(癎)患儿血清神经元特异性烯醇化酶水平与长程视频脑电图异常程度呈正相关(rs=O.613,P=0.000).结论 癫(癎)发作后血清神经元特异性烯醇化酶水平即升高,提示癫(癎)发作对患儿脑组织有一定损害;而且癫(癎)放电对神经元损害越严重、血清神经元特异性烯醇化酶水平升高越明显,不同发作类型中以肌阵挛发作、强直-阵挛发作患儿血清神经元特异性烯醇化酶水平最高,提示这两种发作类型对脑组织的损害高于其他类型.%Objective To explore the relevance between the level changes of serum neuron-specific enolase (NSE) and neuronal damage in various seizure types of children with epilepsy. Methods According to the classification criteria of seizure types formulated by International League Against Epilepsy (ILAE) in 1981, 190 children with epilepsy were enrolled including tonic-clonic seizure group (41 cases), tonic seizure group (34 cases), clonic seizure group (22 cases), myoclonic seizure group (12 cases), atonic seizure group (17 cases), absence seizure group (22 cases), simple partial seizure group (21 cases) and complex partial seizure group (21 cases), and 64 healthy children were enrolled as control group. The long-range vedio-electroencephalogram (VEEG) was operated and the blood samples were collected from these cases within 72 h after their seizures. Results The serum NSE levels of epileptic children were significantly higher than control group (P = 0.000). Among these seizure groups, serum NSE in myoclonic seizure group [(32.42 ± 6.62) ng/ml] was significantly higher than the other types, except for tonic-clonic seizure group (P = 0.062). There was no significant difference among the other types (P > 0.05, for all). According to rank correlation analysis, there was positive corrlation between serum NSE levels and VEEG abnormal intensity (r, = 0.613, P = 0.000). Conclusion The serum NSE were markedly increased in children with epilepsy after seizures, suggesting that a certain degree of neuronal damage may result from seizures; the higher NSE levels were, the more serious neuronal damage caused by epileptiform discharges was. The serum NSE levels in myoclonic seizure group and tonic-clonic seizure group were significantly higher than other seizure types, indicating the two kinds of seizures may result in greater neuronal damage.