蒋静子 俸军林 康俊玲 苏涵

[摘要] 目的 探讨磁共振波谱（MRS）与血药浓度监测在颞叶癫痫诊断与治疗中的意义。 方法 选择2010年10月～2013年10月于桂林医学院附属医院（以下简称“我院”）诊治的颞叶癫痫患者54例，并进行抗癫痫药物血药浓度监测、动态脑电图（AEEG）、MRI和MRS检查；同时选择我院正常体检者20例作为正常对照，并进行AEEG、MRI和MRS检查。MRS检测双侧海马N-乙酰天门冬氨酸（NAA）、肌酸复合物（Cr）和胆碱复合物（Cho）的水平。分析并比较两组的上述检查结果。 结果 ①正常对照AEEG、MRI和MRS均正常；54例颞叶癫痫患者中，AEEG异常31例（57.4%），MRI发现海马硬化19例（35.1%），MRS异常39例（72.2%），血药浓度在有效范围内29例（53.7%），治疗有效32例（59.2%），治疗无效22例（40.7%）。②颞叶癫痫患者病侧的NAA/（Cr+Cho）、NAA/Cr和NAA/Cho值低于对侧和正常对照，差异均有统计学意义（P < 0.05）；患者对侧的NAA/（Cr+Cho）、NAA/Cho值低于正常对照（P < 0.05）。③治疗无效的颞叶癫痫患者NAA/（Cr+Cho）、NAA/Cr和NAA/Cho值低于治疗有效的颞叶癫痫患者（P < 0.05或P < 0.01），而血药浓度在有效范围内患者的NAA/（Cr+Cho）、NAA/Cr和NAA/Cho与有效范围外患者比较，差异无统计学意义（P > 0.05）。 结论 MRS可早期发现颞叶癫痫早期海马生化代谢异常，在早期诊断上有更高的敏感性。

[关键词] 磁共振波谱；癫痫；核磁共振成像；血药浓度监测

[中图分类号] R742.1 [文献标识码] A [文章编号] 1673-7210（2015）06（b）-0047-04

Monitoring serum antiepileptic concentration and magnetic resonance proton spectrum analysis of metabolin in hippocampus by examination in patients with temporal lobe epilepsy

JIANG Jingzi FENG Junlin KANG Junling SU Han

Department of Neurology， the Affiliated Hospital of Guilin Medical University， Guangxi Zhuang Autonomous Region， Guilin 541001， China

[Abstract] Objective To explore the diagnostic and therapeutic value of magnetic resonance proton spectrum （MRS） and plasma concentration monitoring on patients with temporal lobe epilepsy. Methods From October 2010 to October 2013， in the Affiliated Hospital of Guilin Medical University （"our hospital " for short）， 54 patients with temporal lobe epilepsy were selected and given plasma concentration monitoring， AEEG， MRI and MRS； at the same time， 20 healthy physical examination people in our hospital were selected as normal control and given AEEG， MRI and MRS. The metabolic products in hippocampus including N-acetylaspartate （NAA）， creatine （Cr） and choline （Cho） were quantitatively analyzed through MRS on bilateral hippocampus. Above all examination results were analyzed and compared. Results ①The results of AEEG， MRI and MRS in normal control were normal. Among 54 patients， abnormal AFFG were 31 cases （57.4%）， hippocampus sclerosis from MRI were 19 cases （35.1%）， abnormal MRS were 39 cases （72.2%）， plasma concentration of 29 patients （53.7%） were within the effective therapeutic range， effective treatment were 32 cases （59.2%）， ineffective treatment were 22 cases （40.7%）. ②The value of NAA/（Cr+Cho）， NAA/Cr and NAA/Cho in the abnormal side hippocampus of patients were significantly lower than that in the opposite side of hippocampus and normal control， the differences were statistically significant （P < 0.05）； the value of NAA/（Cr+Cho） and NAA/Cho in opposite side were lower than those in the normal control， the differences were statistically significant （P < 0.05）. ③The value of NAA/（Cr+Cho）， NAA/Cr and NAA/Cho of ineffective treatment patients were lower than those of treatment patients （P < 0.05 or P < 0.01）， while there were no significant differences between within plasma concentration monitoring effective range and outside lasma concentration monitoring effective range. Conclusion MRS is more sensitive than MRI in diagnosis and location of epilepsy， MRS can increase the positive rate of early biochemical metabolism change in hippocampus in patients with partial seizure.

[Key words] Magnetic resonance spectroscopy； Epilepsy； Magnetic resonance imaging； Blood concentration monitoring

磁共振波谱（MRS）是现有技术中能检测活体内生化物质改变的唯一非创性技术影像，难治性癫痫的发病机制、脑损伤及预后与脑内多种神经递质有关，多种抗癫痫药物亦通过神经递质起作用。颞叶癫痫主要表现为单纯部分性发作、复杂部分性发作、继发全面性发作或者这些发作形式组合，占全部癫痫比例的30%～35%，大部分均容易发展为难治性癫痫。本研究以颞叶癫痫患者为研究对象，观察比较其血药浓度监测结果、海马代谢物的MRS改变，以及磁共振（MRI）及动态脑电图（AEEG）等改变，探讨磁共振波谱（MRS）与血药浓度监测在颞叶癫痫诊断与治疗中的临床应用价值。……