丘脑底核电刺激对帕金森病患者抑郁的疗效及抑郁与其他症状改善程度的相关性研究  

Effect of subthalamic nucleus deep brain stimulation on depression in patients with Parkinson’s disease and correlation between depression and improvement of other symptoms

作　　者：姜胤 刘钰晔 张鑫[1] 王慧敏[2] 孟凡刚[1] 张凯[2] 张建国[2] JIANG Yin;LIU Yu-ye;ZHANG Xin(Beijing Neurosurgical Institute, Capital Medical University,Beijing 100071, China)

机构地区：[1]首都医科大学北京市神经外科研究所,100071 [2]首都医科大学附属北京天坛医院神经外科

出　　处：《临床神经病学杂志》2019年第5期321-324,共4页Journal of Clinical Neurology

基　　金：“十三五”国家科技支撑计划项目(2016YFC0105-902);国家自然科学基金(81501186);北京市医院管理局“登峰”计划(DFL20150503)

摘　　要：目的探讨丘脑底核电刺激(STN-DBS)对帕金森病(PD)患者抑郁的疗效,并观察其与其他症状改善程度的相关性。方法对70例接受STN-DBS治疗的PD患者进行术前评估及12个月以上追踪,采用统一PD评定量表第三部分(UPDRS Ⅲ)、39项PD调查表(PDQ-39)、汉密尔顿抑郁量表(HAMD)评估患者运动症状、生活质量及抑郁水平,并记录患者PD药物服用情况。结果 PD患者接受STN-DBS治疗1年以上,其运动症状明显改善,PD相关生活质量提高,PD相关药物用量降低(均P<0.001)。HAMD总分及七类因子分在STN-DBS治疗1年后均显著下降(均P<0.05)。PD患者HAMD总分的改善程度与UPDRSⅢ药物"关"期改善及PDQ-39评分改善呈正相关(均P<0.05)。各类因子分别与其他疗效相关分析可见:焦虑/躯体化与UPDRSⅢ药物"关"期改善及PDQ-39评分改善呈正相关(均P<0.05);体质量减轻与药物减量呈负相关(P<0.05);认知障碍、睡眠障碍及绝望感分别与PDQ-39评分改善呈正相关(均P<0.001);阻滞与UPDRS Ⅲ药物"开"、"关"期改善及PDQ-39评分改善分别呈正相关(均P<0.05);日夜变化与其他症状改善之间均无相关性。结论 STN-DBS治疗PD患者1年以上,可显著改善其抑郁障碍。且不同抑郁因子分的改善与生活质量、运动症状改善及药物减量间存在特异相关性。Objective To investigate the effect of subthalamic nucleus deep brain stimulation(STN-DBS) on depression in patients with Parkinson’s disease(PD) and the correlation between depression and improvement of other symptoms. Methods The movement symptom, quality of life and depression level of 70 PD patients treated by STN-DBS for at least 12 months were assessed by unified PD rating scale part Ⅲ(UPDRS Ⅲ), 39 PD questionnaires(PDQ-39) and Hamilton depression scale(HAMD). The usege of PD drugs were also collected. Results After at least one-year STN-DBS treatment, both movement symptom and quality of life improved in PD patients, and drug use also decreased significantly(all P<0.001). HAMD scores and the seven factor scores all decreased after one-year treatment(all P<0.05). The improvement of HAMD total score in PD patients was positively correlated with the improvement of UPDRS Ⅲ drug ‘off’ period and the improvement of PDQ-39 score(all P<0.05). Various factors are related to other curative effects respectively: Anxiety/somatization was positively related to the improvement of UPDRS Ⅲ drug ‘off’ period and the improvement of PDQ-39 score(all P<0.05);Weight loss was negatively related to drug reduction(P<0.05);Cognitive disorders, sleep disorders and feelings of despair were positively correlated with the improvement of PDQ-39 score(all P<0.001). The block were positively correlated with UPDRS Ⅲ drug ‘on’,‘off’ period improvement and PDQ-39 score improvement(all P<0.05). There was no correlation between day and night changes and other symptoms. Conclusions After at least one-year STN-DBS treatment, depression in PD patients could be improved. In addition, different depression factors’ improvement is specifically related to the treatment effect on quality of life, movement symptom and the decrease of drug.

关 键 词：丘脑底核电刺激 帕金森病 抑郁障碍 抑郁因子 

分 类 号：R742.5[医药卫生—神经病学与精神病学]