血脑屏障通透性改变与癫痫发作频率相关性研究  

Study on correlation between changes of blood brain barrier permeability and seizure frequency

作　　者：韩志斌[1] 王贝 张世华[3] 余胜坤 HAN Zhi-bin;WANG Bei;ZHANG Shi-hua;YU Sheng-kun(Department of Neurosurgery,The First Affiliated Hospital of Harbin Medical University,Harbin 150081,China;Department of Neurosurgery,Nanjing Tongren Hospital affiliated to Southeast University,Nanjing 211100,China;Department of Neurosurgery,The First Affiliated Hospital of Jiamusi University,Jiamusi 154007,China;Department of Neurosurgery,The Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 211166,China)

机构地区：[1]哈尔滨医科大学附属第一医院神经外科,黑龙江哈尔滨150081 [2]东南大学附属南京同仁医院神经外科,江苏南京211100 [3]佳木斯大学附属第一医院神经外科,黑龙江佳木斯154007 [4]南京医科大学第四附属医院神经外科,江苏南京211166

出　　处：《临床军医杂志》2024年第12期1219-1222,共4页Clinical Journal of Medical Officers

基　　金：国家自然科学基金联合资助项目(U20A20383)。

摘　　要：目的探讨血脑屏障(BBB)通透性改变与癫痫发作频率之间的相关性。方法选取自2021年1月至2023年12月哈尔滨医科大学附属第一医院、佳木斯医科大学附属第一医院和东南大学附属南京同仁医院收治的182例癫痫患者为研究对象。通过动态对比增强磁共振评估患者的BBB通透性参数,包括血流量(CBF)、血容量(CBV)、容积转运参数(Ktrans),并定期随访癫痫发作频率。采用Spearman或Pearson相关性分析评估BBB通透性参数与癫痫发作频率的关系。采用Logistic多因素回归分析探讨癫痫发作频率的独立影响因素。采用Kaplan-Meier生存分析评估不同Ktrans组别癫痫复发率。比较不同病因、不同发作类型患者的CBF、Ktrans。结果随访期间患者癫痫发作频率总体呈下降趋势。BBB通透性参数Ktrans、CBF、CBV在随访期间逐渐改善,呈降低趋势。相关性分析结果显示,Ktrans与癫痫发作频率呈正相关(r=0.52,P<0.001);CBF与癫痫发作频率呈正相关(r=0.38,P=0.014);CBV与癫痫发作频率无相关性(r=0.22,P=0.091)。Logistic多因素回归分析结果显示,Ktrans、S100B是癫痫发作频率的独立影响因素(P<0.05)。随访24个月时,按所有患者Ktrans值中位数将Ktrans值低于中位数的患者纳入低Ktrans组(n=99),Ktrans值高于中位数的患者纳入高Ktrans组(n=83)。高Ktrans组的无发作存活率为40%,与低Ktrans组的70%比较,差异有统计学意义(P<0.05)。按不同病因将患者分为特发性癫痫组(n=98)与症状性癫痫组(n=84)。特发性癫痫组Ktrans、CBF低于症状性癫痫组,差异有统计学意义(P<0.05)。按不同发作类型将患者分为全身性发作组(n=72)与局灶性发作组(n=110)。全身性发作组Ktrans、CBF与局灶性发作组比较,差异无统计学意义(P>0.05)。结论Ktrans与癫痫发作频率及复发风险密切相关,可作为癫痫发作的潜在预测因子,对临床治疗和预后判断具有重要意义。Objective To investigate the correlation between the changes of blood brain barrier(BBB)permeability and seizure frequency.Methods A total of 182 patients with epilepsy admitted to The First Affiliated Hospital of Harbin Medical University,The First Affiliated Hospital of Jiamusi Medical University and Nanjing Tongren Hospital Affiliated to Southeast University from January 2021 to December 2023 were selected as the study objects.BBB permeability parameters,including cerebral blood flow(CBF),cerebral blood volume(CBV)and volume transfer parameter(Ktrans)were evaluated by dynamic contrast enhanced magnetic resonance imaging,and seizure frequency was regularly followed up.Spearman or Pearson correlation analysis was used to evaluate the relationship between BBB permeability parameters and seizure frequency.Logistic multivariate regression analysis was used to investigate the independent influencing factors of seizure frequency.Kaplan-Meier survival analysis was used to evaluate the recurrence rate of epilepsy in different Ktrans groups.CBF and Ktrans in patients with different etiology and different attack types were compared.Results The frequency of seizures generally decreased during the follow-up period.BBB permeability parameters Ktrans,CBF and CBV gradually improved and showed a decreasing trend during follow-up.Correlation analysis showed that Ktrans was positively correlated with seizure frequency(r=0.52,P<0.001).CBF was positively correlated with seizure frequency(r=0.38,P=0.014).There was no correlation between CBV and seizure frequency(r=0.22,P=0.091).The results of multivariate regression analysis showed that Ktrans and S100B were independent influencing factors of seizure frequency(P<0.05).At 24 months of follow-up,patients with Ktrans values below the median of all patients were included in the low Ktrans group(n=99),and those with Ktrans values above the median were included in the high Ktrans group(n=83).The seizure free survival rate in the high Ktrans group was 40%,compared with 70%in the low Ktran

关 键 词：癫痫发作 血脑屏障 通透性 容积转运参数 生存分析 

分 类 号：R742.1[医药卫生—神经病学与精神病学]