可乐定联合剥夺睡眠诱发癫（癎）发作的SPECT脑血流灌注显像研究  

The study of ictal brain SPECT during seizures induced by clonidine and sleep-deprivation in patients with epilepsy

作　　者：王晓慧[1] 陈雪红[1] 王正江[1] 柳江燕[1] 冯建中[1] 叶江[2] 赵莉[2] 

机构地区：[1]兰州大学第二医院核医学科,730030 [2]兰州大学第二医院癫痫中心,730030

出　　处：《中华核医学杂志》2010年第6期375-378,共4页Chinese Journal of Nuclear Medicine

摘　　要：目的 探讨可乐定加剥夺睡眠诱发癫（癎）发作,获取发作期SPECT显像结果的可行性及临床价值.方法 选择临床确诊的癫（癎）患者52例,口服可乐定并剥夺睡眠以诱发癫（癎）（简称可乐定组）,在视频脑电图（VEEG）监测下,当患者出现临床发作和（或）VEEG出现典型癫（癎）波时,30 s内静脉注射99Tcm-双半胱乙酯（ECD）,30 min后行脑血流灌注断层显像.同时,选择同等条件下癫（癎）患者47例作为对照,通过单纯剥夺睡眠以诱发癫（癎）（简称剥夺睡眠组）.应用SPSS 10.0统计软件对2组患者癫（癎）诱发率进行x2检验.结果 可乐定组的52例癫（癎）患者中,39例（75.0%）口服可乐定后1～2 h出现了VEEG异常,其中亚临床发作（仅出现典型癫（癎）波）92.3%（36/39）,临床发作7.7%（3/39）.发作期SPECT定位阳性率为94.9%（37/39）,均表现为高血流灌注灶.剥夺睡眠组的47例患者中,诱发率为38.3%（18/47）,其中亚临床发作77.8%（14/18）,临床发作22.2%（4/18）.2组诱发率差异有统计学意义（x2=13.614,P＜0.01）;2组临床发作率差异无统计学意义（x2=1.253,P＞0.05）.结论 可乐定联合剥夺睡眠对癫（癎）的诱发率明显高于单纯剥夺睡眠,前者可在有限的时间内诱发癫（癎）,以亚临床发作为主,故可作为进行发作期SPECT脑显像安全、有效的诱发方法.Objective To evaluate the feasibility and clinical value of combined clonidine and sleep-deprivation induced seizures for ictal brain SPECT imaging in patients with epilepsy. Methods Fiftytwo epilepsy patients were given oral clonidine plus sleep-deprivation to induce seizures with video-electroencephalogram （VEEG） monitoring. Forty-seven patients were selected as control group, whose seizures were induced by sleep-deprivation only. 99Tcm-ethylcysteinate dimer （ECD） was injected within 30 s since a clinical sign and/or a typical EEG discharge of epilepsy was recognized. Brain SPECT was performed 30 min after 99TcmECD injection. X2-test was performed by using software SPSS 10. 0. Results One to two hrs after oral intake of clonidine plus sleep-deprivation, 75% （39/52） patients were induced seizures, including 92.3% （36/39） with subclinical seizures and 7.7% （3/39） with clinical seizures. Ictal brain SPECT localized the lesions with high uptake of 99Tcm-ECD in 37 （94.9%） patients. In control group, 38.3% （ 18/47） were induced epileptic seizures, including 77.8% （14/18） with subclinical seizures and 22.2% （4/18） with clinical seizures. The induction rate of epileptic seizures in clonidine plus sleep-deprivation group was significantly higher than that of control group （X2 = 13.614, P 〈 0.01 ）. However, there was no significant difference in clinical seizures between the two groups （X2 = 1.253, P 〉 0.05 ）. Conclusions The combination of oral intake of clonidine and sleep-deprivation could increase the induction rate of epileptic seizures and it is effective for epilepsy SPECT imaging.

关 键 词：癫痫 睡眠剥夺 可乐定 体层摄影术 发射型计算机 单光子 ECD 

分 类 号：R686[医药卫生—骨科学]