双侧丘脑底核脑深部电刺激术对帕金森病患者睡眠及其他非运动症状的治疗效果分析  

Beneficial effect of bilateral subthalamic nucleus deep brain stimulation on sleep disorder and other non-motor symptoms in patients with Parkinson's disease

作　　者：张文颖 牛焕江[2] 朱先理[2] 吕文[1] Zhang Wenying;Niu Huanjiang;Zhu Xianli;Lyu Wen(Department of Neurology,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院神经内科,杭州310016 [2]浙江大学医学院附属邵逸夫医院神经外科,杭州310016

出　　处：《中华神经医学杂志》2020年第9期952-957,共6页Chinese Journal of Neuromedicine

基　　金：浙江省中医药科技计划项目(2015ZA061)。

摘　　要：目的探讨双侧丘脑底核脑深部电刺激术(STN-DBS)对帕金森病(PD)患者睡眠等非运动症状的疗效及相关影响因素。方法选择浙江大学附属邵逸夫医院神经外科自2017年1月至2019年4月行双侧STN-DBS治疗的PD患者36例。术前2周内及术后1年分别对患者进行统一帕金森病评定量表第Ⅲ部分(UPDRSⅢ)、简明精神状态量表(MMSE)、汉密尔顿焦虑量表及抑郁量表(HAMA、HAMD)、非运动并发症30题问卷(NMS)、39项帕金森病生活质量调查表(PDQ39)及帕金森病睡眠评分量表(PDSS)评定,计算总的左旋多巴等效剂量(LED)及多巴胺受体激动剂LED。比较手术前后各项量表评分改善情况,同时分析睡眠症状改善率与各量表评分改善率的相关性。结果与术前相比,患者术后1年时的UPDRSⅢ评分(药物关期)、HAMA评分、HAMD评分、NMS评分、PDQ39评分均显著改善,差异有统计学意义(P<0.05);患者术后总LED、多巴胺受体激动剂LED较术前均明显减少,差异有统计学意义(P<0.05)。与术前比较,患者术后1年时PDSS总分及除PDSS-6、PDSS-15以外的各分项评分均明显改善,差异有统计学意义(P<0.05)。同时,患者术后PDSS总分及各分项评分改善率与UPDRSⅢ评分改善率、HAMA评分改善率、PDQ39评分改善率及总LED的减少率等多存在相关关系。结论双侧STN-DBS能够显著改善患者夜间睡眠质量,部分获益于运动症状的改善及焦虑情绪缓解。Objective To study the beneficial effect of bilateral subthalamic nucleus deep brain stimulation(STN-DBS)on sleep disorder and other non-motor symptoms and their related influencing factors in patients with Parkinson's disease(PD).Methods Thirty-six PD patients accepted bilateral STN-DBS in our hospital from January 2017 to April 2019 were chosen in our study.Two weeks before STN-DBS and one year after STN-DBS,Unified Parkinson's Disease Rating Scale part III(UPDRS III),Mini-Mental State Examination(MMSE),Hamilton Anxiety Rating Scale(HAMA),Hamilton Depression Rating Scale(HAMD),non-motion complications 30 questions questionnaire(NMS),39 quality of life questionnaire for Parkinson's disease(PDQ39)and Parkinson's disease sleep rating scale(PDSS)were performed on these patients,and the levodopa equivalent dose(LED)of drugs and LED of levodopa receptor agonist were calculated.The improvement rate of each scale before and after STN-DBS were compared,and the correlations of improvement of sleep symptom with improvement rates of scores of each scale were analyzed.Results The scores of UPDRS III("off"episodes),HAMA,HAMD,NMS,PDQ39 in patients one year after STN-DBS were significantly lower as compared with those before STN-DBS(P<0.05).The total LED and LED of levodopa receptor agonist in patients one year after STN-DBS were significantly decreased as compared with those before STN-DBS(P<0.05).The total scores of PDSS and sub-scale scores except for PDSS-6 and PDSS-15 scores one year after STN-DBS were significantly higher as compared with those before STN-DBS(P<0.05).The improvement rates of PDSS total scores and sub-scale scores had correlations with improvement rates of UPDRSIII,HAMA and PDQ39 scores,and total LED deceased rate.Conclusion Bilateral STN-DBS can obviously improve the night sleep quality of patients,which is partly benefited from improvement of exercise symptoms and anxiety relief.

关 键 词：帕金森病 脑深部电刺激术 丘脑底核 睡眠质量 

分 类 号：R742.5[医药卫生—神经病学与精神病学]