脑深部电刺激对帕金森病抑郁影响的网状Meta分析  

Effect of deep brain stimulation on depression of Parkinson's disease: a network meta-analysis

作　　者：孔祥薇 康思敏 商慧芳[1] 宋伟[1] KONG Xiangwei;KANG Simin;SHANG Huifang;SONG Wei(Department of Neurology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Neurology,Jiujiang No.1 People's Hospital,Jiujiang,Jiangxi 330200,P.R.China;Department of Neurology,Medical Center Hospital of Qionglai City,Qionglai,Sichuan 611500,P.R.China)

机构地区：[1]四川大学华西医院神经内科,成都610041 [2]九江市第一人民医院神经内科,江西九江330200 [3]邛崃市医疗中心医院神经内科,四川邛崃611500

出　　处：《华西医学》2023年第3期416-423,共8页West China Medical Journal

基　　金：国家老年疾病临床医学研究中心(四川大学华西医院)基础研究重点资助项目(Z2018B08)。

摘　　要：目的比较不同靶点脑深部电刺激(deep brain stimulation,DBS)联合抗帕金森病药物治疗与单用抗帕金森病药物对帕金森病抑郁的影响。方法计算机检索PubMed、Cochrane Library、Embase、中国知网、万方、维普数据库关于帕金森病患者DBS术后抑郁变化的文献,采用Stata 14.0软件进行网状Meta分析。结果共纳入5篇队列研究、7篇RCT研究,共计1241例帕金森病患者。网状Meta分析结果示:以第Ⅰ版贝克抑郁量表评估结果为结局指标,单用药物治疗相对于丘脑底核(subthalamic nucleus,STN)-DBS联合药物治疗抑郁症状加重[标准化均数差(standardized mean difference,SMD)=0.30,95%置信区间(confidence interval,CI)(0.01,0.59),P<0.05],而苍白球内侧核(globus pallidus interna,GPi)-DBS联合药物治疗相较于STN-DBS联合药物治疗[SMD=–0.12,95%CI(–0.41,0.16),P>0.05]、单用药物治疗[SMD=–0.42,95%CI(–0.84,0.00),P>0.05]对抑郁的影响差异无统计学意义;以第Ⅱ版贝克抑郁量表评估结果为结局指标,单用药物治疗相较于STN-DBS联合药物治疗[SMD=0.29,95%CI(0.05,0.54),P<0.05]抑郁加重,GPi-DBS联合药物治疗相较于STN-DBS联合药物治疗[SMD=–0.26,95%CI(–0.46,–0.06),P<0.05]、单独药物治疗[SMD=–0.55,95%CI(–0.88,–0.23),P<0.05]抑郁症状改善。最佳干预措施可能性排序为GPi-DBS联合药物治疗>STN-DBS联合药物治疗>单用药物治疗。结论STN-DBS联合抗帕金森病药物治疗相较于单用抗帕金森病药物治疗,很大可能改善原发性帕金森病患者抑郁症状,GPi-DBS对帕金森病抑郁症状改善效果可能优于STN-DBS。Objective To assess the changes in depression symptoms in patients with Parkinson's disease(PD)receiving combined treatment of deep brain stimulation(DBS)and antiparkinsonian drug therapy(DT)compared with under DT alone.Methods Related literature was retrieved from electronic databases,including PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang Data,and VIP databases.Stata 14.0 software was used for statistical analysis.Network meta-analysis was performed using frequentist model to compare different interventions with each other.Results Five cohort studies and seven randomized controlled trials(RCTs)were included.The total number of participants was 1241.Assessed by the Beck Depression Inventory(BDI)score as the primary outcome,patients who received DT alone showed worse outcome in depression as compared to those who received subthalamic nucleus(STN)-DBS plus DT[standardized mean difference(SMD)=0.30,95%confidence interval(CI)(0.01,0.59),P<0.05],and there was no significant difference between the patients receiving globus pallidus interna(GPi)-DBS plus DT and those receiving STN-DBS plus DT[SMD=-0.12,95%CI(-0.41,0.16),P>0.05]or those receiving DT alone[SMD=-0.42,95%CI(-0.84,0.00),P>0.05].Assessed by BDI-I as the primary outcome,patients who received DT alone showed worse outcome in depression than those who received STN-DBS plus DT[SMD=0.29,95%CI(0.05,0.54),P<0.05];compared with STN-DBS plus DT and DT alone,GPi-DBS plus DT was associated with better improvement in depression[SMD=-0.26,95%CI(-0.46,-0.06),P<0.05;SMD=-0.55,95%CI(-0.88,-0.23),P<0.05].The ranking results of surface under the cumulative ranking curves showed that DBS plus DT had a better superiority in depression symptoms,and GPi-DBS was better than STN-DBS.ConclusionCompared with DT,STN-DBS plus DT is more likely to improve the depressive symptoms of PD patients,and GPi-DBS may be better than STN-DBS.

关 键 词：帕金森病 脑深部电刺激 抑郁 网状Meta分析 

分 类 号：R742.5[医药卫生—神经病学与精神病学]