【摘要】 目的:观察激素甲基泼尼松龙(MPS)和抗癫痫药物左乙拉西坦(LEV)对颅骨成形术后癫痫的预防作用,并观察血液和脑脊液中白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和高迁移率族蛋白B1(HMGB1)水平的变化,探讨炎性介质在癫痫形成中的作用,寻找预防颅骨成形术后癫痫发作的新靶点。方法:采用多中心、前瞻性临床研究。2012年10月-2016年3月接受颅骨成形术患者220例,随机分为LEV预防性应用组80例、MPS预防性应用组40例及对照组100例。术后48周记录患者癫痫发作情况。患者术前24 h及术后2周取血液及脑脊液,酶联免疫吸附法测定HMGB1、IL-6、IL-1β的含量。结果:术后48周内共有25例(11.4%)颅骨成形术后患者发生癫痫发作。有癫痫发作患者于术前、术后血液中IL-6、HMGB1、IL-1β含量均高于无癫痫发作患者,术前、术后脑脊液中IL-6水平均高于无发作患者;LEV组和MPS组血液中IL-6术后水平与术前水平的差值显著低于对照组。结论:颅骨成形术后癫痫发生率较高。IL-6与颅骨成形术后癫痫发作相关,可以作为颅骨成形术后癫痫防治的靶点。更多还原

【Abstract】 Objective: To study the effect of methyllprednisolone(MPS) and levetiracetam(LEV) on prevention of postcranioplasty epilepsy, observe the changes of interleukin(IL)-6, IL-1β and high mobility group box protein 1(HMGB1) in blood and cerebrospinal fluids(CSF), explore the effect of inflammatory media on epileptogenesis, and to search the new targets for preventing post-cranioplasty epilepsy. Methods: In this multi-center prospective study, 220 cases undergoing cranioplasty were collected from Oct. 2012 to Mar. 2016, and randomly divided into LEV group(preventive application of LEV, n=80), MPS group(preventive application of MPS, n=40) and control group(No administration of prophylactic drugs, n=100). Record of epileptic seizures was done 48 weeks after operation. The serum and CSF samples were collected 24 hours before and 2 weeks after operation, and the levels of HMGB1, IL-6 and IL-1β were measured by ELISA. Results: A total of 25 patients(11.4%) underwent post-cranioplasty epilepsy seizures, of them the levels of IL-6, HMGB1 and IL-1β in blood and the level of IL-6 in CSF were higher than those without epilepsy seizures pre-or post-cranioplasty. The difference of pre-and post-operative levels of IL-6 in the blood was significantly lower in LEV group and MPS group than that in control group. Conclusions: The incidence of post-cranioplasty epilepsy is high. IL-6 may be related to post-cranioplasty epileptic seizures, and could be an important target for treatment and prevention of post-cranioplasty epilepsy.更多还原