磁共振引导聚焦超声丘脑消融术对特发性震颤患者同侧肢体震颤改善作用的初步探讨  

A preliminary study on the mechanism of ipsilateral tremor relief in essential tremor patients treated with unilateral MR-guided focused ultrasound thalamotomy

作　　者：周珈右 林家骥 宗睿[2] 尹春宇 刘云默 曾梓敬 陆皓璇 熊永琴 李雪梅[5] 娄昕[3] 潘隆盛[2] Zhou Jiayou;Lin Jiaji;Zong Rui;Yin Chunyu;Liu Yunmo;Zeng Zijing;Lu Haoxuan;Xiong Yongqin;Li Xuemei;Lou Xin;Pan Longsheng(Chinese PLA Medical School,Beijing 100853,China;Department of Neurosurgery,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Radiology,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Neurology,Second Affiliated Hospital of Air Force Medical University,Xi′an 710038,China;Department of Cadres′Outpatient,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心神经外科医学部,北京100853 [3]解放军总医院第一医学中心放射诊断科,北京100853 [4]空军军医大学第二附属医院神经内科,西安710038 [5]解放军总医院第一医学中心门诊部干部诊疗科,北京100853

出　　处：《中华神经外科杂志》2024年第5期461-467,共7页Chinese Journal of Neurosurgery

基　　金：中国人民解放军军队保健专项课题面上项目(22BJZ24)。

摘　　要：目的探讨单侧磁共振引导聚焦超声(MRgFUS)丘脑消融术对特发性震颤(ET)患者同侧手部震颤(简称手颤)的作用及其可能的作用机制。方法回顾性分析2019年1月至2022年6月于解放军总医院第一医学中心神经外科医学部接受单侧MRgFUS丘脑消融术的50例ET患者的临床资料。采用线性混合效应模型对患者术前、术后1、3、6、12个月的手颤评分和非交叉的齿状核-红核-丘脑束(nd-DRTT)纤维连接数进行比较分析,并对患者同侧手颤评分变化中nd-DRTT纤维连接数的中介效应进行检验。结果50例患者术后1、3、6、12个月的消融灶同侧手颤评分分别为(12.6±6.0)分、(12.5±6.5)分、(12.6±6.1)分、(12.8±6.9)分,均低于术前基线评分[(16.1±5.5)分](均P<0.001);术后1、3、6、12个月的消融灶对侧手颤评分分别为(4.1±3.8)分、(4.9±4.5)分、(6.2±5.5)分、(6.9±5.7)分,均低于术前基线评分[(21.5±4.0)分](均P<0.001)。与术前[(150.4±89.9)根]相比,消融灶同侧的nd-DRTT纤维连接数在术后1个月[(38.9±38.0)根]、3个月[(69.2±61.7)根]时显著减少(均P<0.05);而术后6、12个月与术前的差异均无统计学意义(均P>0.05)。消融灶对侧的nd-DRTT纤维连接数在术后各时间点有下降趋势,但与术前的差异均无统计学意义(均P>0.05)。治疗后nd-DRTT纤维连接数的减少(β=-18.64,P=0.001)在ET患者同侧手颤评分的下降中(β=-4.39,P<0.001)具有中介效应(β=0.01,P=0.007)。结论初步研究表明,单侧MRgFUS丘脑消融术可能通过降低同侧的nd-DRTT纤维连接部分介导同侧手颤的缓解。Objective To investigate the effect of unilateral MR-guided focused ultrasound(MRgFUS)thalamotomy on ipsilateral hand tremor in patients with essential tremor(ET)and its possible mechanism.Methods A retrospective analysis was conducted on clinical data of ET patients who received unilateral MRgFUS thalamotomy at the Department of Neurosurgery,First Medical Center of PLA General Hospital from January 2019 to June 2022.The linear mixed-effect model(LMM)was used for the analysis of tremor scores and non-decussating dentato-rubro-thalamic tract(nd-DRTT)at 1,3,6 and 12 months after surgery,as compared to those before surgery.The mediation effect of nd-DRTT in the alteration of ipsilateral tremor scores was also explored.Results Ipsilateral tremor scores of 50 ET patients decreased from 16.1±5.5 to 12.6±6.0,12.5±6.5,12.6±6.1 and 12.8±6.9 at 1,3,6 and 12 months post operation respectively(all P<0.001).Contralateral tremor scores decreased from^(2)1.5±4.0 to 4.1±3.8,4.9±4.5,6.2±5.5 and 6.9±5.7 at 1,3,6 and 12 months post operation respectively(all P<0.001).Compared with preoperative level(150.4±89.9),there was a significant decrease in the number of ipsilateral nd-DRTT both at 1 month(38.9±38.0)and 3 months(69.2±61.7)after thalamotomy(both P<0.05),while no statistically significant decrease was observed at 6 and 12 months(both P>0.05).Compared with preoperative level(132.6±75.6),the number of contralateral nd-DRTT after thalamotomy at different time points showed a decreasing trend,but did not reach statistical significance(all P>0.05).The decrease of nd-DRTT after thalamotomy(β=-18.64,P=0.001)had a mediation effect(β=0.01,P=0.007)in the decrease of ipsilateral tremor score(β=-4.39,P<0.001).Conclusion Preliminary results show that unilateral MRgFUS thalamotomy could partially mediate the relief of ipsilateral tremor via reducing ipsilateral nd-DRTT.

关 键 词：特发性震颤 丘脑腹中间核 治疗结果 机制 高强聚焦超声消融 弥散张量成像 

分 类 号：R651.1[医药卫生—外科学]