不同类型帕金森病患者丘脑底核电刺激长期疗效分析  

Long-term efficacy of subthalamic nuclei electrical stimulation in different subtypes of Parkinson disease

作　　者：徐翠萍[1] 庄平[1] 张宇清[1] 李建宇[1] 胡永生[1] 李勇杰[1] 

机构地区：[1]首都医科大学宣武医院 北京市功能神经外科研究所 教育部神经变性病学重点实验室 北京脑重大疾病研究院 帕金森病研究所 帕金森病研究北京市重点实验室,100053

出　　处：《神经疾病与精神卫生》2015年第5期445-448,共4页Journal of Neuroscience and Mental Health

基　　金：国家自然科学基金（83171256,81361128012,81171061）;种子基金（PXM2014-014226-000015）

摘　　要：目的：分析不同类型帕金森病（PD ）患者双侧丘脑底核（STN ）深部电刺激（DBS ）术后的长期疗效。方法选择行双侧STN －DBS治疗的49例原发性PD患者，其中男27例，女22例；年龄平均（56．8±9．4）岁；病程平均（8．2±4．1）年。采用PD统一评分量表（UPDRS）分别在术前关期、开期和术后关期、开期对患者进行疗效评估。根据术前关期U PDRSⅢ的震颤评分和非震颤评分将患者分为震颤型、僵直迟缓型和混合型3组。应用配对 t检验比较3组患者术前和术后的U PDRS评分。结果术后平均随访时间为（4．8±1．4）年。关期 PD患者的UPDRSⅢ运动改善率为50．8％，UPDRSⅡ日常生活能力改善率为32．9％。其中僵直迟缓型患者术后日常生活能力提高（ P＜0．05），僵直迟缓型和混合型患者术后U PDRSⅢ总分及各分项评分（震颤、僵直、迟缓、姿势稳定性和步态障碍）均改善（ P ＜0.05）；震颤型患者术后震颤症状改善（P ＜0．05）。僵直迟缓型患者术后异动症持续时间减少，异动症病残程度降低（P ＜0．05）。3组患者术后多巴胺类药物日摄入剂量均较术前减少（P＜0．05）。长期疗效分析显示部分僵直迟缓型和混合型患者吞咽障碍、语言障碍加重（P ＜0．05）。3组患者的刺激脉宽、频率和电压差异无统计学意义（P ＞0．05）。结论双侧STN －DBS可以长期有效改善不同症状类型PD患者的运动症状和异动症，减少多巴胺类药物的日摄入剂量，但对于部分病程进展较快的僵直迟缓型和混合型患者，STN －DBS不能有效改善吞咽障碍、语言障碍等中线症状。Objective To assess the long -term efficacy of deep brain stimulation （DBS） in bilater‐al subthalamic nucleus（STN） with different subtypes of Parkinson disease（PD） .Methods A total of 49 cases of idiopathic PD patients treated with bilateral STN -DBS ,including 27 males and 22 females were analyzed .The average age was （56 .8 ± 9 .4） years old and the mean disease duration was （8 .2 ± 4 .1） years .Unified Parkinson＇s Disease Rating Scale （UPDRS） was assessed in on and off period before and after STN -DBS .Based on the UPDRS Ⅲ tremor and non -tremor scores in preoperative off period , patients were divided into tremor -dominant type （TDT ） ,rigidity slow type （ART ） ,and mixed type （MT） preoperatively .Paired t test was carried out to compare the UPDRS scores with preoperative and postoperative patients in three subtypes .Results After （4 .8 ± 1 .4） average years of follow up ,for all patients in off period ,UPDRS Ⅲ sports improvement rate was 50 .8% ,UPDRS Ⅱ daily life ability im‐provement rate was 32 .9% .Postoperative daily living of rigidity slow patients significantly increased （P 〈 0 .05）;UPDRS Ⅲ score and each item score including tremor ,rigidity ,slow ,postural stability and gait disturbance were significantly improved after surgery in rigidity slow and mixed patients （P 〈0.05） .In particular ,tremor symptoms were obviously improved in tremor patients （P〈 0 .05） .The du‐ration of dyskinesia reduced significantly and degree of disability decreased in rigidity slow patients after surgery ,the difference was statistically significant （P 〈 0 .05） .The daily intake dose of dopamine was reduced than preoperative in three types of patients .However ,long -term efficacy analysis showed that swallowing disorders ,language barriers were getting worsen in part of rigidity slow and mixed patients （P 〈 0 .05） .Stimulation pulse width ,frequency and voltage in three groups had no obvious difference . Conclusions Bilateral STN -DBS

关 键 词：帕金森病 丘脑底核 深部脑刺激法 长期疗效 

分 类 号：R742.5[医药卫生—神经病学与精神病学]