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目的:探讨人类大脑中主要的抑制性神经递质GABA(γ-氨基丁酸)对癫痫患者大脑代谢的作用。方法:二组接受癫痫部位颅内监测的患者:手术治疗的海马区癫痫症患者(MTLE)和新皮质区(非海马区癫痫)癫痫症患者。在颅内监测过程中使用体内微量透析法监测胞外GABA(ec GABA)。术前使用体内核磁共振成像技术检测N-乙酰天冬氨酸(NAA)与肌酸(NAA/Cr)的比例。使用标准方法进行神经病理学和海马体积检测。结果:在新皮质区组的海马区内,ec GABA的升高与NAA/Cr的升高相关(R=+0.70,P<0.015,n=12),而在MTLE组的海马区中,ec GABA的升高是由NAA/Cr的下降所引起的(R=0.94,P<0.001,n=8)。在MTLE组,ec GABA的升高和NAA/Cr的降低皆与神经胶质细胞数的增多有关(分别为R=+0.71,P<0.01,n=12和R=0.76,P<0.03)。二组中ec GABA的浓度和海马体积均没有明显的相关性。结论:在癫痫症中,ec GABA的升高是由一系列的代谢功能变化引起的。在癫痫部位以外,ec GABA和NAA/Cr同步升高;而在癫痫部位,线粒体功能的下降却伴随着ec GABA的升高。
Objective: To investigate the effect of GABA (γ-aminobutyric acid), a major inhibitory neurotransmitter in human brain, on cerebral metabolism in epileptic patients. METHODS: Two groups of patients undergoing intracranial monitoring of epilepsy were undergone surgical treatment of patients with epilepsy in the hippocampus epilepsy (MTLE) and neocortex (non hippocampal epilepsy) epilepsy. Ex vivo GABA (ec GABA) was monitored using in vivo microdialysis during intracranial monitoring. The ratio of NAA to creatine (NAA / Cr) was measured preoperatively using in vivo magnetic resonance imaging. Neuropathology and hippocampal volume detection were performed using standard methods. RESULTS: In the hippocampus of the neocortex group, the elevation of ecGABA was associated with an increase in NAA / Cr (R = +0.70, P <0.015, n = 12), whereas in the hippocampal area of the MTLE group, ec Elevated GABA was caused by a decrease in NAA / Cr (R = 0.94, P <0.001, n = 8). In the MTLE group, both elevation of ecGABA and decrease of NAA / Cr were associated with an increase in the number of glial cells (R = +0.71, P <0.01, n = 12 and R = 0.76, P <0.03, respectively). There was no significant correlation between the concentration of ecA GABA and the volume of hippocampus in both groups. Conclusion: In epilepsy, the increase of ec GABA is caused by a series of changes in metabolic function. Outside of the epilepsy, ec GABA and NAA / Cr are elevated simultaneously, whereas in the epileptic region, the decrease in mitochondrial function is accompanied by an increase in ec GABA.