丘脑底核脑深部电刺激术治疗晚期帕金森病的疗效分析  

Efficacy of deep brain stimulation of the subthalamic nucleus in the treatment of advanced Parkinson′s disease

作　　者：苗壮壮 蒋伟 舒凯[1] 雷霆[1] Miao Zhuangzhuang;Jiang Wei;Shu Kai;Lei Ting(Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《中华神经外科杂志》2022年第11期1098-1102,共5页Chinese Journal of Neurosurgery

基　　金：湖北省自然科学基金(2020CFB572)。

摘　　要：目的探讨丘脑底核脑深部电刺激术(STN-DBS)治疗晚期帕金森病的疗效。方法筛选28例2015年5月至2019年10月在华中科技大学同济医学院附属同济医院神经外科接受STN-DBS治疗的晚期帕金森病患者。回顾性评估左旋多巴等效日剂量(LEDD)及药物并发症的改善情况,分析术后统一帕金森病评定量表Ⅲ部分(UPDRS-Ⅲ)总分及其分类评分、非运动症状的改善情况。结果术后1年LEDD[M(Q1,Q3)]为393.8(250.0,500.0)mg,与术前的812.5(750.0,1168.9)mg比较,差异有统计学意义(P<0.001)。药物引发的剂末效应、异动症、开关现象的发生率均降低(均P<0.05)。术后1个月、1年的UPDRS-Ⅲ总分为15.0(9.3,18.0)分、26.0(21.3,28.0)分,与术前的37.0(35.0,43.8)分比较,差异均有统计学意义(均P<0.001)。UPDRS-Ⅲ分类评分中,术后1个月、1年,静止性震颤、姿势性震颤、四肢动作、行动迟缓、姿势评分均较术前改善明显,差异均有统计学意义(均P<0.001);而强直、言语表情及步态评分,仅术后1个月较术前改善明显(均P<0.001),术后1年差异无统计学意义(均P>0.05);吞咽困难评分呈恶化趋势(P=0.006)。术后1年部分非运动症状改善(均P<0.05)。结论晚期帕金森病患者STN-DBS后短期运动症状改善明显,术后1年随访部分运动症状及非运动症状效果有限;STN-DBS可降低药物相关并发症。Objective To investigate the efficacy of deep brain stimulation of the subthalamic nucleus(STN-DBS)in the treatment of advanced Parkinson′s disease(PD).Methods Twenty-eight patients with advanced PD who received STN-DBS at the Neurosurgery Department of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from May 2015 to October 2019 were enrolled.Postoperative overall and classified scores of Unified PD Rating Scale PartⅢ(UPDRS-Ⅲ),improvement of non-motor symptoms,improvement of levodopa equivalent daily dose(LEDD)and drug complications were evaluated retrospectively.Results One year after operation,the LEDD[M(Q1,Q3)]was 393.8(250.0,500.0)mg,which was significantly different compared with 812.5(750.0,1168.9)mg before operation(P<0.001).The incidences of drug-induced wearing-off effect,dyskinesia and on-off phenomenon were all decreased(all P<0.05).The total score of UPDRS-Ⅲat 1 month and 1 year after operation was 15.0(9.3,18.0)points and 26.0(21.3,28.0)points respectively,which were significantly different compared with 37.0(35.0,43.8)points before operation(both P<0.001).In terms of the UPDRS-Ⅲclassified items,the scores of resting tremor,postural tremor,limb movement,bradykinesia,and posture were significantly improved at 1 month and 1 year after operation,and the differences were statistically significant(all P<0.001).However,the scores of rigidity,speech,countenance and gait were significantly improved only at 1 month after operation(all P<0.001),and the difference was not statistically significant at 1 year after operation(all P>0.05).The dysphagia score showed a worsening trend(P=0.006).Some non-motor symptoms improved at 1 year after operation(all P<0.05).Conclusions STN-DBS significantly improves motor symptoms in patients with advanced Parkinson′s disease in the short term,and has limited effect on some motor symptoms and non-motor symptoms at 1-year follow-up after surgery.It can also reduce drug-related complications.

关 键 词：帕金森病 深部脑刺激法 丘脑底核 治疗结果 晚期 

分 类 号：R651.1[医药卫生—外科学]