脑立体定向损毁术与脑深部电刺激术比较治疗帕金森的meta分析  

Meta-analysis of brain stereotactic lesion and deep brain stimulation in treating Parkinson

作　　者：王超[1] 谷艳霞[1] 李婷婷[1] 陈钜涛[1] 张峥[1] 陈阳[1] 石昭坤 屈媛[1] 张兆辉[1] 

机构地区：[1]武汉大学人民医院神经内科,湖北武汉430000

出　　处：《职业与健康》2017年第4期465-469,共5页Occupation and Health

摘　　要：目的比较神经损毁术和脑深部电刺激术(deep brain stimulation,DBS)2种手术改善帕金森晚期患者症状的安全性和有效性。方法计算机检索中国知网(CNKI)、万方、维普、the Cochrane Central Register of Controlled Trials(CENTRAL)、Pub Med、EMbase,查找所有比较神经核团损毁术和DBS治疗帕金森的研究,检索时间均为建库至2015年12月25日。按纳入排除标准进行筛选、资料提取和质量评价后,运用Revman 5.2软件进行meta分析,并采用评估、制定与评价(GRADE)系统进行证据评价。结果共纳入10个研究,1 752例患者。Meta分析结果显示:(1)在安全性方面,2组在术后并发症方面差异有统计学意义[OR=0.25,95%CI(0.07,0.92),P=0.04],DBS术后并发症出现少于神经核团损毁术;(2)在有效性方面,两组术后1个月帕金森综合评分量表(UPDRS)运动评分差异无统计学意义(P=0.08),2组术后1个月日常生活能力量表(ADL)评分差异无统计学意义(P=0.14),2种手术术后多巴胺用量差异有统计学意义(MD=-0.35,95%CI(-0.39,-0.31),P<0.000 01),DBS组术后左旋多巴胺用量较少;2组术后复发率差异无统计学意义(P=0.25)。根据系统评价结果,采用GRADE系统推荐分级方法评价证据质量及推荐等级,结果显示,证据水平为低级,推荐强度为弱推荐。结论神经核团损毁术和DBS对帕金森晚期患者治疗效果相似,但DBS治疗的患者并发症出现概率较小,DBS术后患者左旋多巴胺用量较少;但因原始研究质量较低以及临床上两种手术价格等原因,应综合考虑后慎重选择。[Objective] To compare the safety and efficacy of stereotactic intracerebral nucleus lesion and deep brain stimulation in improving the symptoms of late Parkinson patients. [Methods] The database of CNKI,Wanfang,VIP,the Cochrane Central Register of Controlled Trials（CENTRAL）,Pub Med and EMbase were searched from their establishment to December 25 th,2015for collecting the studies about stereotactic intracerebral nucleus lesion and deep brain stimulation in treating Parkinson. After filtering,data extraction and quality evaluation according to inclusive and exclusive criteria,meta-analyses were performed by Revman 5.2 software. The evidence assessed was carried out by GRADE system. [Results]A total of 10 studies involving 1 752 patients were included. The results of meta-analysis showed that ：（1）in safety： the difference of postoperative complications in two groups was statistically significant[OR=0.25,95%CI（0.07,0.92）,P=0.04],the postoperative complications of DBS was less than stereotactic intracerebral nucleus lesion;（2）in efficacy： the differences of scores of UPDRS and ADL one month after surgery in two groups were not statistically significant（P =0.08,0.14）. The difference of Dopamine dosage after surgery was statistically significant（MD=-0.35,95%CI（-0.39,-0.31）,P〈0.000 01）,the L-Dopamine dosage of DBS was less. The difference of recurrence rate after surgery was not statistically significant（P =0.25）. According to the results of system assessment,the evidence quality and recommended levels were evaluated by GRADE system,the results showed that evidence level was low and mended strength was weak recommendation. [Conclusion]The effect of stereotactic intracerebral nucleus lesion and deep brain stimulation in treating late Parkinson is similar,but the Patients with DBS have less postoperative complications and less dosage of L-Dopamine after surgery. For the poor quality of original studies and two operation prices,a prudent choice after comprehensive consideration is su

关 键 词：帕金森病 神经核团损毁术 脑深部电刺激术 META分析 系统评价 

分 类 号：R74[医药卫生—神经病学与精神病学]