颞叶内侧硬化的组织学分型及临床病理相关性  

Histological classification and clinico-pathological correlation study for mesial temporal sclerosis

作　　者：阮清源[1] 倪海春[1] 朴月善[1] 卢德宏[1] 遇涛[2] 肖东升[2] 隗立峰[1] 赵莉红[1] 

机构地区：[1]首都医科大学宣武医院病理科,北京100053 [2]首都医科大学宣武医院功能神经外科,北京100053

出　　处：《中华神经科杂志》2012年第12期874-878,共5页Chinese Journal of Neurology

基　　金：北京市卫生系统高层次卫生技术人才培养计划资助项目（2011-3-095）

摘　　要：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CA1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1a型：10／19，1b型：7／16，2型：4／7，3型：0（χ2=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。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 CAt--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 1a（21/51,41.18% ） ：severe cell loss in CA1 and moderate neuronal loss in all other subfields excluding CA2 ; Type lb（ 18/51, 35.2% ） ： severe cell loss in all sectors; Type 2（9/51, 17. 65% ） ：severe neuronal loss restricted to sector CAl ;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 1 a was 10/19, type 1b was 7/16, type 2 was 4/7, type 3 was 0 （χ2 = 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.

关 键 词：癫痫 颞叶 海马 硬化 病理学 临床 

分 类 号：R742.1[医药卫生—神经病学与精神病学]