摘要
目的：探讨脑瘫肌痉挛形成的机制及选择性脊神经后根切断术（ＳＰＲ）后脊髓中枢的改变。方法：采用丹酰氯－聚酰胺薄膜层析法，测定了２４例痉挛型脑瘫、３１例非神经系统疾病儿童及１２例ＳＰＲ后脑瘫患儿脑脊液中兴奋性、抑制性氨基酸水平。结果：痉挛型脑瘫患儿脑脊液中γ－氨基丁酸低于对照组（Ｐ＜０．００１），谷氨酸、天冬氨酸高于对照组（Ｐ＜０．００１），谷氨酸与患儿增高的肌张力呈等级正相关；ＳＰＲ后，γ－氨基丁酸、丙氨酸、甘氨酸明显升高，且高于正常组（Ｐ＜０．０５），谷氨酸、天冬氨酸明显下降，且谷氨酸低于正常组（Ｐ＜０．０５）。结论：突触前抑制下降、脊神经后根传入纤维侧支出芽、突触再建在脑瘫肌痉挛形成中起了重要的作用；ＳＰＲ后，脑脊液中兴奋性氨基酸下降、抑制性氨基酸上升与肌痉挛的解除有关，抑制性氨基酸能神经元侧支出芽。
Objective: To investigate the mechanism of spasticity in cerebral palsy and the changes in cerebrospinal fluid after selective posterior rhizotomy(SPR). Methods:Cerebrospinal fluid was obtained from spastic cerebral palsy group (CP, n=24), control group (those without central nervous system pathology, n=31) and the operated group (SPR, n=12). The latter were CP children who underwent SPR. The concentrations of inhibitory amino acids (IAAs) and excitatory amino acids (EAAs) in cerebrospinal fluid were determined by dimethylaminonaphthalenessulfonyl chloride with polyamid thinlayer chromatography. Results: Prior to SPR, the level of GABA was significantly lower than that of the control (P<0.001) whereas GA and Asp were significantly higher than that of the control group (P<0.001). The level of GA correlated positively with muscle tone. After SPR, the levels of IAAs increased and were higher than that of control group (P<0.05) while the level of GA decreased and was lower than that of control group (P<0.05). Conclusions: The decrease of presynaptic inhibition and formation of new synapses by sprouting of afferent axon terminals probably play a role in spasticity of cerebral palsy. After SPR, the decrease of EAAs in CSF is associated with release of spasticity. Excitability of EAAergic neurons and formation of new synapses by IAAergic neuron sprouts may contribute to the new balance between inhibition and excitation in spinal cord.
出处
《中华小儿外科杂志》
CSCD
1998年第5期282-282,共1页
Chinese Journal of Pediatric Surgery
关键词
兴奋性氨基酸
抑制性
脑瘫
脊神经后根切断
Excitatory amino acids Inhibitory amino acids Cerebral palsy Cerebrospinal fluid Selective posterior rhizotomy
