外侧缰核脑深部电刺激治疗难治性抑郁症的前瞻性研究  

A prospective study of deep brain stimulation of lateral habenula nucleus for the treatment of refractory depression

作　　者：江潮 范滕滕 王志燕 关凌霄 胡春华[3] 王健[1] 崔志强[1] Jiang Chao;Fan Tengteng;Wang Zhiyan;Guan Lingxiao;Hu Chunhua;Wang Jian;Cui Zhiqiang(Department of Neurosurgery,the First Medical Center,PLA General Hospital,Beijing 100853,China;Peking University Sixth Hospital,Peking University Institute of Mental Health,National Health Commssion Key Laboratory of Mental Hygiene,National Clinical Research Center for Mental Illness,Beijing 100191,China;National Engineering Research Center of Neuromodulation,School of Aerospace Engineering,Tsinghua University,Beijing 100084,China;Chinese Academy of Sciences Key Laboratory of Mental Health,Institute of Psychology,Beijing 100101,China;Department of Psychology,University of Chinese Academy of Sciences,Beijing 100049,China)

机构地区：[1]解放军总医院第一医学中心神经外科医学部,北京100853 [2]北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室,国家精神心理疾病临床医学研究中心,北京100191 [3]清华大学航天航空学院,神经调控国家工程研究中心,北京100084 [4]中国科学院心理健康重点实验室(中国科学院心理研究所),北京100101 [5]中国科学院大学心理学系,北京100049

出　　处：《中华神经外科杂志》2024年第4期348-353,共6页Chinese Journal of Neurosurgery

基　　金：国家重点研发计划(2019YFC0118500)。

摘　　要：目的探讨外侧缰核脑深部电刺激治疗难治性抑郁症的有效性和安全性。方法纳入2021年3月至2022年4月解放军总医院第一医学中心神经外科医学部行外侧缰核脑深部电刺激(LHb-DBS)手术治疗的6例难治性抑郁症患者进行前瞻性研究。术前1个月及术后开机1、3、6、9、12、15个月分别进行汉密尔顿抑郁量表(HDRS)-17、汉密尔顿焦虑量表(HAMA)、蒙哥马利抑郁量表(MADRS)、匹兹堡睡眠质量指数(PSQI)、快速抑郁症症状自评问卷(QIDS-SR)、功能大体评定量表(GAF)等的评估。同时记录手术和刺激相关的并发症。结果6例患者的手术均顺利完成。5例患者随访至开机后15个月,1例随访至开机后1个月。开机后1个月时,与术前基线相比,6例患者的HDRS-17评分(平均改善率为60.3%)、HAMA评分(平均改善率为59.6%)、MADRS评分(平均改善率为61.1%)、QIDS-SR评分(平均改善率为55.2%)均下降,GAF评分(平均改善率为46.9%)升高。与术前基线比较,5例患者开机后3~15个月抑郁相关量表HDRS-17、MADRS、QIDS-SR评分的平均改善率分别为60.3%~67.6%、64.7%~79.4%、47.4%~63.2%;焦虑情绪方面,HAMA评分的平均改善率为57.7%~71.6%;睡眠方面,PSQI评分的平均改善率为17.2%~31.7%;GAF评分提高47.6%~87.6%。在围手术期及随访期间,无一例发生术中出血、脑缺血、切口感染等手术相关并发症,未观察到与器械相关的不良事件。在治疗期间,4例患者记录到与刺激相关的不良事件,经调整刺激触点和刺激参数后缓解。结论采用LHb-DBS治疗难治性抑郁症患者可改善抑郁、焦虑,提高患者的生活质量,且未观察到手术及刺激相关的严重并发症。Objective To investigate the efficacy and safety of deep brain stimulation of lateral habenula nucleus(LHb-DBS)for the treatment of refractory depression.Methods Aprospective study was conducted on 6 patients with refractory depression who underwent deep brain stimulation of LHb-DBS in the Department of Neurosurgery of the First Medical Center of PLA General Hospital from March 2021 to April 2022.The Hamilton Depression Rating Scale(HDRS)-17,Hamilton Anxiety scale(HAMA),Montgomery-Asberg Depression Rating Scale(MADRS),Pitsburgh Sleep Quality Index(PSQI),Quick Inventory of Depressive Symptomatology-Self-Report(QIDS-SR)and Global Assessment Function(GAF)were used for assessment 1 month before surgery and 1,3,6,9,12,and 15 months after surgery respectively.Complications related to surgery and stimulation were also documented.Results All 6 patients successfully underwent surgery.Five patients were followed up to 15 months after start-up of the DBS device,and one case was followed up to 1 month after start-up.At 1 month post start-up,the HDRS-17 score(average improvement rate:60.3%),HAMA score(average improvement rate:59.6%),MADRS score(average improvement rate:61.1%)and QIDS-SR score(average improvement rate:55.2%)were all decreased compared with the preoperative baseline,while the GAF score(average improvement rate:46.9%)was increased.In the follow-up of 3-15 months after start-up,compared with the preoperative baseline,the average improvement rate of depression-related scale HDRS-17,MADRS and QIDS-SR scores in 5 patients was 60.3%-67.6%,64.7%-79.4%and 47.4%-63.2%.For anxiety,the average improvement rate of HAMA score ranged from 57.7%to 71.6%.In terms of sleep,the average improvement rate of PSQI score was 17.2%-31.7%.The GAF score was increased by 47.6%-87.6%.During the perioperative period and follow-up period,there were no cases of surgery-related complications such as intraoperative hemorrhage,ischemia,or wound infection,and no device-related adverse events were observed.During the treatment period,stimulus-rel

关 键 词：抑郁症 难治性 深部脑刺激法 前瞻性研究 外侧缰核 

分 类 号：R651.1[医药卫生—外科学]