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目的探讨氢质子磁共振波谱(proton magnetic resonance spectroscopy,1H-MRS)检测在热性惊厥(febrile seizure,FS)及癫癎(epilepsy,EP)中的临床应用价值及意义。方法2006—2007年收治惊厥患儿共41例,其中FS组25例,其中单纯性热性惊厥(simple febrile seizure,SFS)组15例及复杂性热性惊厥(complex febrile seizure,CFS)组10例;EP组16例,按有无合并热性惊厥史分为伴有热性惊厥组7例和不伴热性惊厥组9例。对热性惊厥和癫癎患儿进行常规头颅磁共振(MRI)及颞叶海马区1H-MRS检查,并选择6例神经系统正常儿童作对照组。1H-MRS检测指标:N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)、谷氨酸-谷氨酰胺复合物(Glx)和乳酸(Lac)的信号强度,计算NAA/(Cho+Cr)和Lac/Cr的比值,并进行比较。结果头颅MRI检查结果:FS组及对照组均正常,EP组除1例髓鞘发育不良外余均正常。1H-MRS检查结果显示:NAA/(Cho+Cr)比值SFS组为0.71±0.05,CFS组为0.65±0.04,EP组为0.62±0.04(其中伴有热性惊厥史EP组为0.60±0.03,不伴有热性惊厥史的EP组为0.64±0.04),对照组为0.73±0.05。NAA/(Cho+Cr)比值在CFS组与EP组之间无明显差异(P>0.05),但两组均低于对照组(P<0.01);CFS组明显低于SFS组及对照组(P<0.01),但后两者差异无统计学意义(P>0.05);伴有热性惊厥史的EP组低于不伴有热性惊厥史的EP组(P<0.05)。Lac/Cr比值SFS组(0.32±0.21)和CFS组(0.63±0.30)不仅高于对照组(0.05±0.04)(P<0.05),也明显高于EP组(0.11±0.09)(P<0.05);CFS组Lac/Cr高于SFS组,P<0.01;EP组Lac/Cr与对照组比较无明显差异。结论(1)NAA/(Cho+Cr)比值是反映脑损伤的客观指标,该指标在CFS及EP患儿脑组织中下降,提示存在神经元丢失或功能失常。(2)Lac/Cr比值是反映脑急性缺氧的指标,该指标在SFS及CFS患儿脑组织中升高,提示惊厥过程中存在脑局部缺血,即使是短暂单次的惊厥发作亦存在脑损伤。(3)1H-MRS作为一项无创的检查,能更敏感地发现FS及EP患儿的早期脑损伤,有助于弥补MRI的不足及其他有创检查的损伤,为FS及EP患儿治疗、评估预后提供客观依据。
Objective To investigate the clinical value and significance of proton magnetic resonance spectroscopy (1H-MRS) in febrile seizure (FS) and epilepsy (EP). Methods A total of 41 children with convulsions were enrolled in this study. Among them, 25 patients were treated with FS, 15 patients in simple febrile seizure (SFS) group and 10 patients in complex febrile seizure (CFS) group In the EP group, 16 cases were divided into 7 cases with febrile seizure group and 9 cases without febrile convulsion group according to the history of febrile seizures. The patients with febrile seizures and epilepsy were examined by conventional head MRI and 1H-MRS in the temporal lobe hippocampus. Six children with normal nervous system were selected as the control group. 1H-MRS detection: signal intensity of NAA, Cr, Gl, Glx and Lac, The ratio of NAA / (Cho + Cr) to Lac / Cr was calculated and compared. Results The results of cranial MRI examination showed that both FS group and control group were normal, while EP group was normal except one case of myelodysplasia. The results of 1H-MRS showed that the ratio of NAA / (Cho + Cr) was 0.71 ± 0.05 in SFS group, 0.65 ± 0.04 in CFS group and 0.62 ± 0.04 in EP group (EP group was 0.60 ± 0.03 in EP group) EP group with no history of febrile seizures was 0.64 ± 0.04), and the control group was 0.73 ± 0.05. NAA / (Cho + Cr) ratio in CFS group and EP group had no significant difference (P> 0.05), but both groups were lower than the control group (P <0.01); CFS group was significantly lower than the SFS group and the control group P <0.01). However, there was no significant difference between the two groups (P> 0.05). The EP group with febrile seizures was lower than the EP group without febrile seizures (P <0.05). The Lac / Cr ratio in SFS group (0.32 ± 0.21) and CFS group (0.63 ± 0.30) was not only higher than that in control group (0.05 ± 0.04) (P <0.05), but also significantly higher than that in EP group (0.11 ± 0.09) ); LacS in CFS group was higher than that in SFS group, P <0.01; Lac / Cr in EP group showed no significant difference compared with control group. Conclusions (1) The ratio of NAA / (Cho + Cr) is an objective indicator of brain injury. This index is decreased in brain tissue of children with CFS and EP, suggesting the presence of neuronal loss or dysfunction. (2) The Lac / Cr ratio is an index of acute cerebral hypoxia. This index is elevated in the brain tissue of children with SFS and CFS, which indicates that there is cerebral ischaemia during convulsion. Even a brief episode of convulsive seizure also exists Brain Injury. (3) 1H-MRS as a noninvasive examination can more sensitively detect early brain injury in children with FS and EP, help to make up for the lack of MRI and other invasive examination of the injury, for the treatment of children with FS and EP , To assess the prognosis to provide an objective basis.