中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2012年
12期
874-878
,共5页
阮清源%倪海春%朴月善%卢德宏%遇涛%肖东升%隗立峰%赵莉红
阮清源%倪海春%樸月善%盧德宏%遇濤%肖東升%隗立峰%趙莉紅
원청원%예해춘%박월선%로덕굉%우도%초동승%외립봉%조리홍
癫痫,颞叶%海马%硬化%病理学,临床
癲癇,顳葉%海馬%硬化%病理學,臨床
전간,섭협%해마%경화%병이학,림상
Epilepsy,temporal lobe%Hippocampus%Sclerosis%Pathology,clinical
目的 探讨颞叶内侧硬化组织学特点和分型以及临床病理的相关性.方法 对51例颞叶内侧癫痫患者的手术切除标本,行神经元核抗原(NeuN)免疫组织化学染色后显微镜下计数海马4个亚区神经元数量,进行统计学分析(k-均值聚类分析).同时收集患者的临床资料,包括初次发作癫痫的年龄、有无突发脑损伤、潜伏期、癫痫病程、术后半年及1年癫痫疗效Engel评分,分析不同病理类型的临床特点.另选取8例无神经系统病变的尸检患者的海马标本作为对照组.结果 (1)海马神经元丢失表现为5种不同的组织学类型:1a型(21/51,41.18%):CA1区神经元重度丢失同时伴有CA3、CA4区神经元轻度丢失,CA2区神经元无明确丢失;1b型(18/51,35.29%):所有亚区神经元均严重丢失;2型(9/51,17.65%):仅有CAt区神经元重度丢失;3型(1/51,1.96%):仅CA4区神经元重度丢失;无海马硬化型(2/51,3.92%):与对照组相比海马各亚区神经元无明显丢失.(2)1型(1a、1b)海马硬化患者首次发作癫痫的年龄更小,潜伏期及病程更长,有突发脑损伤病史的比例更高,其中有热性惊厥病史的1 a型:10/19,1b型:7/16,2型:4/7,3型:0(x2=11.790,P =0.019).(3)海马硬化严重程度与手术预后呈正相关.结论 1型海马硬化为颞叶内侧硬化中最常见的类型,与早期突发脑损伤尤其是热性惊厥密切相关,术后癫痫的控制率高于其他三型.
目的 探討顳葉內側硬化組織學特點和分型以及臨床病理的相關性.方法 對51例顳葉內側癲癇患者的手術切除標本,行神經元覈抗原(NeuN)免疫組織化學染色後顯微鏡下計數海馬4箇亞區神經元數量,進行統計學分析(k-均值聚類分析).同時收集患者的臨床資料,包括初次髮作癲癇的年齡、有無突髮腦損傷、潛伏期、癲癇病程、術後半年及1年癲癇療效Engel評分,分析不同病理類型的臨床特點.另選取8例無神經繫統病變的尸檢患者的海馬標本作為對照組.結果 (1)海馬神經元丟失錶現為5種不同的組織學類型:1a型(21/51,41.18%):CA1區神經元重度丟失同時伴有CA3、CA4區神經元輕度丟失,CA2區神經元無明確丟失;1b型(18/51,35.29%):所有亞區神經元均嚴重丟失;2型(9/51,17.65%):僅有CAt區神經元重度丟失;3型(1/51,1.96%):僅CA4區神經元重度丟失;無海馬硬化型(2/51,3.92%):與對照組相比海馬各亞區神經元無明顯丟失.(2)1型(1a、1b)海馬硬化患者首次髮作癲癇的年齡更小,潛伏期及病程更長,有突髮腦損傷病史的比例更高,其中有熱性驚厥病史的1 a型:10/19,1b型:7/16,2型:4/7,3型:0(x2=11.790,P =0.019).(3)海馬硬化嚴重程度與手術預後呈正相關.結論 1型海馬硬化為顳葉內側硬化中最常見的類型,與早期突髮腦損傷尤其是熱性驚厥密切相關,術後癲癇的控製率高于其他三型.
목적 탐토섭협내측경화조직학특점화분형이급림상병리적상관성.방법 대51례섭협내측전간환자적수술절제표본,행신경원핵항원(NeuN)면역조직화학염색후현미경하계수해마4개아구신경원수량,진행통계학분석(k-균치취류분석).동시수집환자적림상자료,포괄초차발작전간적년령、유무돌발뇌손상、잠복기、전간병정、술후반년급1년전간료효Engel평분,분석불동병리류형적림상특점.령선취8례무신경계통병변적시검환자적해마표본작위대조조.결과 (1)해마신경원주실표현위5충불동적조직학류형:1a형(21/51,41.18%):CA1구신경원중도주실동시반유CA3、CA4구신경원경도주실,CA2구신경원무명학주실;1b형(18/51,35.29%):소유아구신경원균엄중주실;2형(9/51,17.65%):부유CAt구신경원중도주실;3형(1/51,1.96%):부CA4구신경원중도주실;무해마경화형(2/51,3.92%):여대조조상비해마각아구신경원무명현주실.(2)1형(1a、1b)해마경화환자수차발작전간적년령경소,잠복기급병정경장,유돌발뇌손상병사적비례경고,기중유열성량궐병사적1 a형:10/19,1b형:7/16,2형:4/7,3형:0(x2=11.790,P =0.019).(3)해마경화엄중정도여수술예후정정상관.결론 1형해마경화위섭협내측경화중최상견적류형,여조기돌발뇌손상우기시열성량궐밀절상관,술후전간적공제솔고우기타삼형.
Objective To study a histopathological classification system for hippocampal cell loss in patients suffering from mesial temporal lobe epilepsy.Methods Fifty-one surgically resected specimens were microscopically examined with respect to neuronal cell loss in hippocampal subfields CA1—CA4.Clinical data including age at first seizure,with or without initial precipitating injuries (IPIs),latecy,epilepsy duration,Engel score of half and one year after surgery were collected to analyse the clinical characteristics between different pathological types.Eight additional hippocampal specimens obtained from neurologically healthy autopsies served as controls.Results (1)Five distinct patterns were recognized within a consecutive cohort of anatomically well-preserved surgical specimens.Type 1 a (21/51,41.18 %):severe cell loss in CA1 and moderate neuronal loss in all other subfields excluding CA2; Type 1b(18/51,35.2%):severe cell loss in all sectors; Type 2(9/51,17.65%):severe neuronal loss restricted to sector CA1 ;Type 3 (1/51,1.96%):severe neuronal loss restricted to the hilar region; no mesial temporal sclerosis (2/51,3.92%):a group comprised hippocampi with neuronal cell densities not significantly different from age matched autopsy controls.(2)The patients of type 1 a and 1 b had younger age of first onset,longer latency and duration,more frequency of IPIs,the proportion of ourrence of febrile seizures in type 1a was 10/19,type 1b was 7/16,type 2 was 4/7,type 3 was 0 (x2 =11.790,P =0.019).(3) The patients of type 1a and 1 b had better postsurgical outcome.Conclusion Type 1 is the most common type of mesial temporal sclerosis,which have better postsurgical outcome than the other 3 types.