本文選題：難治性癲癇 + 睡眠��； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的： 離子通道變異、神經(jīng)遞質(zhì)改變、睡眠因子改變以及神經(jīng)網(wǎng)絡(luò)重塑等均參與了癲癇的發(fā)生，但癲癇的發(fā)病機(jī)制錯(cuò)綜復(fù)雜，仍不十分清楚。本研究探討難治性癲癇患者致癇灶中HCN1、GABAA受體α1亞基以及腺苷A2a受體的表達(dá)。 方法： 24例難治性癲癇患者（實(shí)驗(yàn)組）行癲癇致癇灶切除術(shù)，6例行尸體解剖者（對(duì)照組）剖檢，兩組術(shù)后標(biāo)本進(jìn)行光鏡、電鏡及免疫組化檢查，觀察HCN1、GABAA受體α1亞基以及腺苷A2a受體三者的表達(dá)變化。 結(jié)果： 1.實(shí)驗(yàn)組腦組織光鏡下可見(jiàn)神經(jīng)元分布不均勻，神經(jīng)元丟失、變性，胞核呈空泡狀，胞質(zhì)少，膠質(zhì)細(xì)胞增生以及噬神經(jīng)細(xì)胞現(xiàn)象、衛(wèi)星現(xiàn)象等病理改變。電鏡下可見(jiàn)細(xì)胞核異染色質(zhì)凝集，呈塊狀，近核膜排列或散在分布；核基質(zhì)略致密；胞質(zhì)內(nèi)粗面內(nèi)質(zhì)網(wǎng)擴(kuò)張，部分線粒體嵴斷裂，基質(zhì)局部空化；可見(jiàn)多個(gè)空泡。 2.實(shí)驗(yàn)組和對(duì)照組均可見(jiàn)HCN1、GABAAα1、A2a蛋白表達(dá)的陽(yáng)性細(xì)胞，三者在神經(jīng)元細(xì)胞實(shí)驗(yàn)組陽(yáng)性表達(dá)率分別為79.4%，95.0%，94.8；對(duì)照組陽(yáng)性表達(dá)率分別為94.8%，76.7%，77.5%。三者在兩組間差異具有統(tǒng)計(jì)學(xué)意義（P㩳0.01）。膠質(zhì)細(xì)胞實(shí)驗(yàn)組中HCN1、GABAAα1陽(yáng)性表達(dá)率與對(duì)照組之間無(wú)統(tǒng)計(jì)學(xué)差異（79.3%vs.81.8%,67.3%vs.64.7%；P0.05），A2a蛋白表達(dá)兩組間具有顯著統(tǒng)計(jì)學(xué)意義（89.1%vs.77.4%, P 0.01）。 3.將實(shí)驗(yàn)組難治性癲癇患者按照取材部位分為額葉、顳葉兩組，統(tǒng)計(jì)兩組中HCN1、GABAAα1、A2a的表達(dá)情況。額顳兩組間HCN1陽(yáng)性表達(dá)率有統(tǒng)計(jì)學(xué)差異(92.4%vs.82.9%,P 0.01)；而兩組間GABAAα1、A2a陽(yáng)性表達(dá)率無(wú)明顯差異(93.3%vs.90.6%,94.4%vs.94.8%, P0.05)。根據(jù)發(fā)作頻率將實(shí)驗(yàn)組患者分為每月發(fā)作＜10次、每月發(fā)作≥10次兩組，統(tǒng)計(jì)兩組中HCN1、GABAAα1、A2a的表達(dá)情況。HCN1, A2a的陽(yáng)性表達(dá)率發(fā)作頻率高組與發(fā)作頻率低組之間有明顯差異(91.7%vs.83.1%,89.2%vs.96.4%,P0.01)，但兩組間GABAAα1表達(dá)無(wú)明顯差異(90.9%vs.91.5%, P0.05)。 4.實(shí)驗(yàn)組患者術(shù)前行PSQI評(píng)分，分為PSQI㩳5、6-10、11-15、PSQI㧐16四組，，統(tǒng)計(jì)四組中睡眠相關(guān)因子HCN1、GABAAα1、A2a蛋白表達(dá)水平。PSQI㩳5與PSQI㧐16兩組的HCN1、A2a陽(yáng)性率之間無(wú)顯著差異(95.6%vs.94.3%,81.0%vs.83.9%, P0.05),兩組間GABAA受體α1亞單位表達(dá)率有統(tǒng)計(jì)學(xué)差異(97.4%vs.91.6%, P0.01)。 結(jié)論： 1.HCN1、GABAAα1、A2a在難治性癲癇患者致癇灶神經(jīng)元及膠質(zhì)細(xì)胞中廣泛表達(dá)； 2.難治性癲癇患者HCN1通道表達(dá)降低，且HCN1表達(dá)情況與發(fā)病頻率相關(guān)。難治性癲癇患者致癇灶內(nèi)GABAA受體α1亞單位表達(dá)增加，與亞單位類(lèi)型、受體表達(dá)的部位和癲癇狀態(tài)有關(guān)。難治性癲癇患者致癇灶腦組織中A2a受體表達(dá)活躍，腺苷受體表達(dá)與癲癇病程具有時(shí)間相關(guān)性。 3. PSQI㧐16患者腦組織中GABAA受體α1亞單位表達(dá)降低。
[Abstract]:Objective: Ion channel variation, neurotransmitter changes, sleep factor changes and neural network remodeling are all involved in the occurrence of epilepsy. However, the pathogenesis of epilepsy is complex and unclear. This study was to investigate the expression of GABAA receptor 偽 1 subunit and adenosine A 2a receptor in epileptogenic foci of patients with intractable epilepsy. Methods: Twenty-four patients with intractable epilepsy (experimental group) underwent excision of epileptogenic foci and 6 cases of cadaveric dissection (control group). The specimens of both groups were examined by light microscope, electron microscope and immunohistochemistry. The expression of GABAA receptor 偽 1 subunit and adenosine A 2a receptor were observed. Results: 1. In the experimental group, the distribution of neurons was uneven, the neurons were lost, denatured, the nucleus was vacuolated, the cytoplasm was low, glial cell proliferation, neuronal phagocytosis, satellite phenomenon and other pathological changes were observed under the light microscope. Under electron microscope, nuclear heterochromatin agglutination was seen, which was massive, near nuclear membrane arrangement or scattered; nuclear matrix was slightly dense; cytoplasmic rough endoplasmic reticulum dilated; part of mitochondria crest was broken, matrix was local cavitation, and several vacuoles were observed. 2. The positive expression rates of GABAA 偽 1a 2a protein were found in the experimental group and the control group respectively. The positive expression rates of the three proteins in the neuron cell experimental group were 79.4% and 95.0% respectively, and the positive expression rates in the control group were 94.8% and 77.5%, respectively. The difference between the three groups was statistically significant (P < 0.01). There was no significant difference in the expression rate of GABAA 偽 1 between the glial cells experimental group and the control group. There was no significant difference between the two groups in the expression of HCN1- GABAA 偽 1 protein. There was a significant difference between the two groups in the expression of HCN1 + GABAA 偽 1 protein. 3. The patients with intractable epilepsy in the experimental group were divided into frontal lobe group and temporal lobe group according to the location of the material, and the expression of GABAA 偽 1a 2a in the two groups was counted. There was significant difference in the positive expression rate of HCN1 between the two groups (92.4vs.82.9) and between the two groups (P 0.01a), but there was no significant difference in the positive expression rate of GABAA 偽 1a A2a between the two groups. There was no significant difference between the two groups (93.3 vs.90.6) and 94.4vs.94.8. According to the frequency of attack, the patients in the experimental group were divided into two groups: the number of seizures < 10 times per month and the number of episodes 鈮

本文編號(hào)：1953685