脑深部电刺激术治疗Hoehn-Yahr分期2.5~5期PD患者单中心长期随访研究  

Deep brain stimulation in patients with Parkinson's disease at Hoehn-Yahr stage 2.5-5: a single-center long-term follow-up study

作　　者：孙健 邱畅 董文文 罗备 卢越 常磊 闫久祺 章文斌[1] Sun Jian;Qiu Chang;Dong Wenwen;Luo Bei;Lu Yue;Chang Lei;Yan Jiuqi;Zhang Wenbin(Department of Functional Neurosurgery,Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院功能神经外科,南京210029

出　　处：《中华神经医学杂志》2023年第8期794-800,共7页Chinese Journal of Neuromedicine

基　　金：江苏省重点研发专项资金(BE2022049、BE2022049-1);南京市卫生科技发展专项资金(ZKX20031)。

摘　　要：目的:探讨脑深部电刺激术(DBS)治疗Hoehn-Yahr分期2.5~5期帕金森病(PD)患者的长期临床效果以及不同Hoehn-Yahr分期患者间临床效果的区别。方法:选择南京医科大学附属脑科医院功能神经外科自2014年5月至2016年12月应用DBS治疗的69例PD患者(Hoehn-Yahr分期2.5期7例、3期27例、4期31例、5期4例)进行术后60个月的长期随访观察。分别在患者术前抗PD药物"关"期状态及术后6、12、24、36、48、60个月时DBS开机持续治疗下药物"关"期状态进行统一帕金森病评定量表(UPDRS)评估,分别在患者术前及术后6、12、24、36、48、60个月时进行帕金森患者生活质量问卷(PDQ-39)评估、左旋多巴等效剂量(LED)数据采集,在术后12个月时采集患者DBS刺激参数并计算出总刺激功率、单脉冲平均能量、较大单脉冲能量。比较患者术前及术后不同时间点UPDRS-Ⅲ评分、PDQ-39评分、LEDD的差异,比较不同Hoehn-Yahr分期患者术后不同时间点UPDRS-Ⅲ评分、PDQ-39评分的差异,以及术后12个月时DBS刺激参数的差异。结果:与术前比较,患者术后6、12、24、36、48、60个月时UPDRS-Ⅲ评分、PDQ-39评分及LED均明显降低,差异均有统计学意义(P<0.05)。除术后12、24个月时Hoehn-Yahr分期5期患者与Hoehn-Yahr分期2.5期、3期患者的UPDRS-Ⅲ评分差异均有统计学意义(P<0.05)外,Hoehn-Yahr分期5期患者与Hoehn-Yahr分期4期患者的UPDRS-Ⅲ评分差异无统计学意义(P>0.05),以及其余时间点时Hoehn-Yahr分期5期患者与Hoehn-Yahr分期2.5期、3期、4期患者的UPDRS-Ⅲ评分差异均无统计学意义(P>0.05)。不同Hoehn-Yahr分期患者术后6、12、24、36、48、60个月时PDQ-39评分的差异均无统计学意义(P>0.05)。不同Hoehn-Yahr分期患者术后12个月时总刺激功率、单脉冲平均能量及较大单脉冲能量的差异均无统计学意义(P>0.05)。结论:DBS对Hoehn-Yahr分期2.5~5期PD患者运动功能及生活质量的改善长期有效,且HoehObjective To investigate the long-term clinical effect of deep brain stimulation(DBS)on patients with Parkinson's disease(PD)at Hoehn-Yahr stage 2.5-5 and the differences of clinical effect among patients at different Hoehn-Yahr stages.Methods A total of 69 PD patients(7 at Hoehn-Yahr stage 2.5,27 at stage 3,31 at stage 4,and 4 at stage 5)accepted DBS in Department of Functional Neurosurgery,Affiliated Brain Hospital of Nanjing Medical University from May 2014 to December 2016 were selected for long-term follow-up observation at 60 months after DBS.Unified Parkinson's Disease Rating Scale(UPDRS)was evaluated in the"off"phase of the patients before DBS and the"off"phases of the drugs under DBS start-up and continuous treatment at 6,12,24,36,48 and 60 months after DBS,respectively;Parkinson's Quality of Life Questionnaire(PDQ-39)and levodopa equivalent dose(LED)data were collected before and 6,12,24,36,48 and 60 months after DBS.DBS parameters of the patients were collected at 12 months after DBS;the total stimulation power,single pulse average energy and large single pulse energy were calculated.The differences in UPDRS-III scores,PDQ-39 scores and LEDD in these patients before DBS and at different time points after DBS were compared;the differences in UPDRS-III and PDQ-39 scores at different time points after DBS and postoperative DBS parameters at 12 months after DBS in patients at different Hoehn-Yahr stages were compared.Results Compared with those before DBS,the UPDRS-III scores,PDQ-39 scores and LED were significantly reduced at 6,12,24,36,48 and 60 months after DBS(P<0.05).Significant differences in UPDRS-III scores were noted between patients at Hoehn-Yahr stage 5 and Hoehn-Yahr stage 2.5 and stage 3 at 12 and 24 months after DBS(P<0.05);however,no significant differences in UPDRS-III scores were noted between patients at Hoehn-Yahr stage 5 and Hoehn-Yahr stage 4 at same time points(P>0.05);and no significant differences in UPDRS-III scores were noted between patients at Hoehn-Yahr stage 5 and patients at

关 键 词：帕金森病 脑深部电刺激术 Hoehn-Yahr分期 长期疗效 刺激参数 

分 类 号：R742.5[医药卫生—神经病学与精神病学]