【作者】 陈丽琼；

【导师】 李海波；

【作者基本信息】 吉林大学 ， 儿科学， 2004， 硕士

【摘要】 目的：癫痫是神经系统常见疾病之一，其总体预后较好，但仍有相当部分病人用目前的治疗方法难以奏效而成为难治性癫痫，难治性癫痫的发病机制则成为近年来研究的重点，其中耐药基因的表达增高引起了医学界的关注，本实验通过检测多药耐药基因表达产物细胞膜糖蛋白P170在癫痫儿童外周血淋巴细胞的表达水平，初步探讨儿童癫痫与多药耐药基因的相互关系，并指导临床治疗。方法：采用流式细胞仪分析法检测吉林大学第一医院儿科门诊及住院部2003年4月-2003年12月收治的25例癫痫儿童外周血淋巴细胞P170表达水平，均符合目前癫痫的诊断依据：⑴有典型的临床发作；⑵脑电图检查有典型癫痫波；⑶除外非癫痫性发作及其它发作性疾病。其中难治性癫痫组患儿符合目前国内对难治性癫痫的论述：临床经过迁延，频繁的癫痫发作至少每个月4次以上，应用适当的第一线抗癫痫药物正规治疗，药物的血中浓度在有效范围内，无严重的不良反应，至少观察2年仍不能控制发作，影响日常生活同时并无进行性中枢神经系统疾病或占位性病变，排除由于诊断错误、选药不当、用量不足、依从性差等因素所造成的所谓“医源性”难治性癫痫。根据发作类型、脑电图结果、临床治疗效果分为难治性癫痫组、部分性发作癫痫组、全身性发作癫痫组；正常对照组为年龄、性别与研究组无明显差异的健康儿童。结果：（1）各种发作类型癫痫患儿外<WP=29>周血淋巴细胞P170表达水平均高于正常对照组，经SLD-t检验差异显著（P<0.05），其中难治性癫痫组患儿外周血淋巴细胞P170表达水平(36.1713±5.67%)明显高于正常对照组(1.4980±0.48%)，经SLD-t检验差异显著（P<0.001）；（2）难治性癫痫组患儿与另两组非难治性癫痫组患儿比较，外周血淋巴细胞P170表达水平存在差异，经SLD-t检验有统计学意义（P<0.05）;（3）全身发作性癫痫组与部分发作性癫痫组外周血淋巴细胞P170表达水平(21.2113±4.32%,16.4743±2.04%)相近（P>0.05），无显著差异。结论：P170表达增高可能参与难治性癫痫耐药性的形成；P170的增高可能与癫痫发作及抗癫痫药物诱导有一定的关系，故早期、合理用药，积极控制癫痫的发作可能会减少耐药性形成；P170可以作为难治性癫痫早期诊断的外周指标之一；定期复查P170的表达水平，可以发现耐药性的形成，指导临床合理用药。更多还原

【Abstract】 Objective: Epilepsy(EP) is a common disease in nervous system, which collective prognosis is preferable, but sill a part of its can’t cure with therapeutic Method at present，which is intractable epilepsy. the pathogenesis of IP becomes the study keystone, and the heighten of MDR’s expression causes medical attention. the objection is studying the relation between the epilepsy in children and multi-drug resistance gene and discussing the likely pathogenesis. Method: To detect the expressive levels of perihemo-lymphcell membrance glyco-protein in 25 children with of epilepsy and 8 healthy children by flow cytometer analytic method. All the studied objects’conditions are coincidence with the diagnosis standards about epilepsy and intractable epilepsy at present, eliminating the other out-breaking diseases. According to the clinical situation.、electroencephalogram results and clinical therapy results, these studied objects are divided into intractable epilepsy group、partial seizure group、total seizure group；the control group is 8 healthy children without difference on age and sex. Results: (1) the expressive levels of perihemo-lymphcell membrance glyco-protein in all 25 children with epilepsy were higher compared to the control group(1.4980±0.48),and the levels of perihemo-lymphcell membrance glyco-protein in children with intractable epilepsy(36.1713±5.67%) were highest ,detected by SLD-t,(P<0.001)there was statistic significance.(2) The expressive levels of perihemo-lymphcell membrance glyco-protein in 8 children <WP=31>with intractable epilepsy were higher compared to the other children with tractable epilepsy(21.2113±4.32%,16.4743±2.04%) ,detected by SLD-t(P<0.05),there was statistic difference.(3)There were no statistic difference between the two group children with common epilepsy, detected by SLD-t(P>0.05), there was no statistic significance .Conclusion: the heighten expressive level of P170 is likely one of the pathogenesis of intractable epilepsy;P170 may act the diagnostic marker of intractable epilepsy; the expressive levels’ heighten of perihemo-lymphcell membrance in children with epilepsy may caused by diseases itself and ADES itself, So early 、reasonably、 actively control the attack of epilepsy may less the formation of intractable epilepsy; The level of P170 may be helpful to detect the formation of drug-resistance early. Thus the level of P170 in blood has an important clinical significance.更多还原