单侧颞叶癫病人双侧基底节区多体素MRS研究

摘要

Objebtive To detect the metabolic changes in the bilateral basal ganglia regions of unilateral temporal lobe epilepsy (TLE) with multivoxel magnetic resonance spectroscopy. Methods Ten patients with left temporal lobe epilepsy, ten patients with right temporal lobe epilepsy, and 10 healthy volunteers were selected. Unilateral TLE were diagnosed based on clinical onset symptoms and EEG. The Liverpool seizure severity scale (LSSS) 2.0 was measured from all patients. Multivoxel 1H-MRS data were acquired by SIEMENS 3.0 superconducting MR scanner. Concentrations of N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr) were measured symmetrically from bilateral head of caudate nucleus, putamen, and thalamus. The NAA/Cr and Cho/Cr ratios of each area of interest were calculated for inter-group statistical analysis. Pearson correlation analysis between metabolite ratios and LSSS 2.0 score were carried out. Results The NAA/Cr ratios of the left and right thalamus were 1.92 ±0.15 and 2.02 ±0.26, respectively, in the left TLE group;and 2.19 ±0.16 and 1.79±0.16, respectively, in the right TLE group. The ratios were significantly lower (P<0.05) than that of the control group which were 2.37±0.14 and 2.36±0.10, respectively. In the right TLE group, the NAA/Cr ratios of the ipsilateral thalamus was significant lower than that of the contralateral thalamus (1.79 ±0.16 vs 2.19 ±0.16, P<0.05). For TLE patients, the NAA/Cr ratios of the ipsilateral thalamus negatively correlated with LSSS 2.0 score (left TLE r=-0.667;right TLE r=-0.643, all P<0.05). Conclusion Patients with unilateral TLE have neuronal loss and/or dysfunction of bilateral thalamus, and both NAA/Cr ratios of the ipsilateral thalamus and LSSS 2.0 score can reflect the severity of seizures.%目的：采用多体素MRS探讨单侧颞叶癫日（TLE）病人双侧基底节区代谢物改变。方法选取根据临床发作症状和脑电图综合诊断的左侧TLE病人10例，右侧TLE病人10例，正常志愿者10例纳入研究。所有TLE病人均进行利物浦日性发作严重程度量表2．0（LSSS 2．0）评估，采用Simens 3．0 T超导MR设备进行多体素1H-MRS数据采集，对称性测量双侧尾状核头、豆状核和丘脑的N-乙酰天门冬氨酸（NAA）、乙酰胆碱（Cho）、肌酸（Cr）含量，计算各兴趣区NAA/Cr和Cho/Cr比值并进行统计学分析，将代谢物比值与LSSS 2．0评分进行Pearson相关分析。结果左侧TLE组双侧丘脑NAA/Cr比值分别为1．92±0．15（左）和2．02±0．26（右），右侧TLE组双侧丘脑NAA/Cr比值分别为2．19±0．16（左）和1．79±0．16（右），均明显低于对照组[2．37±0．14（左）和2．36±0．10（右），P＜0．05]。右侧TLE组，其致日灶同侧丘脑的NAA/Cr比值较对侧丘脑要低（P＜0．05）。TLE组致日灶同侧丘脑NAA/Cr比值与LSSS 2．0评分呈负相关（左侧r=-0．667；右侧r=-0．643，均P＜0．05）。结论单侧TLE病人存在双侧丘脑神经元丢失和/或功能障碍，且致日灶同侧丘脑NAA/Cr比值与LSSS 2．0评分可以一致性反映近期日性发作严重程度。