帕金森病外科治疗的综合评价与相关基础研究  

Basic research and comprehensive evaluation of surgical treatment on Parkinson's disease

作　　者：常义[1] 杨纶先[1] 马骏[1] 陈永严[1] 刘宏毅[1] 李乐加[1] 邹元杰[1] 肖红[1] 赵鹏来[1] 

机构地区：[1]南京医科大学附属南京脑科医院神经外科,210029

出　　处：《临床神经外科杂志》2006年第1期19-21,共3页Journal of Clinical Neurosurgery

摘　　要：目的通过综合研究对帕金森病(PD)外科治疗的价值和疗效进行全面评价。方法采用医学心理学测验(WAISRC)、临床记忆量表(MMPI)、神经生理学检测(听觉P300地形图)、神经电生理学(体感诱发电位SEP)和神经生化检查的脑脊液中多巴胺(DA)、5羟色胺(5HT)、去甲肾上腺素(NE)及其代谢产物)等对手术前后患者进行综合研究,并设对照组。结果手术前后智能和精神症状无显著性差异(P>0.05);手术后SEP的N20波峰潜伏期较术前缩短,统计学处理有差异(P左<0.005,P右<0.05),手术侧较非手术侧峰潜伏期缩短(P<0.05)。伴发抑郁患者组CSF中单胺类神经递质5HT的代谢产物5羟吲哚乙酸(5HIAA)和NE的代谢产物3甲氧基4羟基苯乙二醇(MHPG)低于对照组(P<0.01),患者组DA、高香草酸(HVA),5HT,5HIAA、NE、MPHG低于正常对照组(P<0.001),手术组上述各项均高于手术前组(P<0.001);结论手术不会加重智能和精神障碍;听觉P300地形图可作为诊断和疗效判定的客观指标之一;帕金森病及伴发抑郁症状均具有相应生化病理学基础。Objective Comprehensively evaluate the value and effect of surgical management for Parkinson＇s disease（PD） through multitudinous analysis. Methods Pre- and postoperative results were analyzed through trial controlled study of neuropsychological Weschler adult intelligence scale （WAIS-RC）, clinical memory rating scale, Mommesota multiphasic personality inventory （ MMPI ） assessments, neurophysiological examina-tions （ P300 from auditory stimuli ）, somato-sensory evoked potential （SEP）, brainstem auditory evoked potential （BAEP） and neurochemistry examinations of cerebral spinal fluid （ CSF ） levels of dopamine （ DA ）, 5-hydroxytryptamine （ 5-HT）, nor pinephrine （NE） and their metabolites. Rnsults Intelligence and mental disorders acquired no significant changes（ P 〈0.5 ） after surgery. Latent period of N20 peak of SEP shortened significantly after operation（ P 〈0.005, P 〈 0.05 ）. CSF levels of 5-hydroxyindoleacetic acid （ 5-HIAA ） and 3-methoy-4-hydroxy-phenylglycol （ MHPG ） in PD patients with depression were significantly lower than that in contral group （ P 〈 0.01 ）. CSF levels of DA, homovanilic acid （HVA）,5-HT, 5-HIAA, NE, MPHG are lower in patients than that in controlled group （P 〈 0. 001 ）,and elevated after surgery. Conclusions Surgical management will not aggravate intellectual and mental disorders;P300 is objective criteria of therapy evalution; the occurrence of depression in PD patients has its biochemical and pathological basis.

关 键 词：帕金森病 外科治疗 综合评价 基础研究 

分 类 号：R742.5[医药卫生—神经病学与精神病学]