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1、难治性癫痫手术联合免疫治疗前后体液免疫状况调查【摘要】目的:回顾性分析难治性癫痫患者手术联合免疫治疗前后的体液免疫水平。方法:对43例难治性癫痫患者分别采取相应手术方式进行治疗,术后遵循个体化原则服用抗癫痫药,并联合胸腺肽进行治疗,随访3-6个月,采用ELISA法及速率散射浊度法对术前、术后一周、术后三个月及半年的血清免疫球蛋白及补体水平进行检测比较。结果:①临床疗效:手术后12例终止发作,13例显效,10例有效,5例效差,3例无效,海马硬化者手术效果好。②体液免疫检测结果:癫痫患者免疫球蛋白(IgA.IgG)及补体C3水平于术后一周低于术前(P<0.01)
2、,海马硬化者明显,术后三个月至半年逐渐升高,且明显高于术前水平。IgM及C4在手术前后无明显变化。结论:难治性癫痫患者免疫功能低下或紊乱,手术联合免疫治疗能有效控制或减少癫痫发作并有助于改善患者免疫功能。【关键词】难治性癫痫;免疫球蛋白;补体;手术治疗;免疫治疗。【中图分类号1R742[文献标识码】A文章编号:1004-7484(2012)-05-0797-02[Abstract】Objective:Toretrospectivelyanalyzetheimmunityofpatientswithintractableepilepsywhohavetaken
3、operationandimmunethreapy.Methods:Forty-threecasesofpatientswithintractableepilepsyweretakenappropriateoperationspectively,supplementedwithpostoperativeantiepilepticdrugsandthymosinfortreatment,foMowingupforthreetosixmonths,usingthemethodofELISAandratenephelometricturbiditymethodto
4、testtheimmunoglobulinandcomplementinseruminthetimeofpreoperative,postoperativeweek,threemonthsaftertheoperationandsixmonthafterthat・Results:First,theclinicalcurativeeffectofforty-threeisthattwelvecasesaquiredfreedomafteroperation,tencasesofeffective,fivecasesofpooreffectsand3casesi
5、neffective,thepatientswhohadhippocampalsclerosisaquiredbettereffectthanothers.Second,theimmunoglobulin(IgA,IgG)andC3ofpostoperativeweekarelowerthanthatofproperation(P<0.01),especialyinpatientswhohavehippocampalsclerosis,Andwhatwasincreasedgraduallyinthreetosixmonthsandwassignifican
6、tlyhigherthanthepreoperative.IgMandC4havenosignifiesntdifferencesbeforeemdafteroperation.Conclusion:Theintractableepilepsyhaveimmunedysfunctionorimmunocompromiseddisorder,operationcombinedwithimmunetherapycaneffectivelycontroltheepilepticseizuresorreducethefrequencyofthemandcontrib
7、utetotheimprovementofimmunefunction.[Keywords]Intractableepilepsy;Immunoglobulin;Comp1ement;Operation;Immunotherapy难治性癫痫(intractableep订epsy,IE)又称顽固性癫痫。是指频繁的大脑神经元异常放电引起的短暂中枢神经系统功能失常,至少每月4次,应用适当的一线抗癫痫药物治疗且血药浓度在有效范围内,仍不能控制发作且影响日常生活的慢性脑部疾病[1]。其类型多,病因复杂,发病机制尚未完全阐明。自从1969年Walker提出癫痫免疫学发病
8、机制以来[2],多数研究表明,癫痫的发病过程伴有免疫