丘脑底核脑深部电刺激治疗对帕金森病患者药物运动并发症的疗效及其相关临床评分影响

doi:10.19854/j.cnki.1008-2425.2024.06.0001

摘要/Abstract

摘要： 目的评估丘脑底核(subthalamic nucleus,STN)脑深部电刺激( deep brain stimulation,DBS)对帕金森病(Parkinson's disease,PD)患者因药物引起的运动并发症治疗效果及其相关临床评分的影响。同时,探索STN-DBS对其运动并发症改善与其他临床评分(如焦虑、抑郁、认知功能等)的相互关系,以深入理解其治疗机制。方法纳入2019年9月至2020年6月期间在中国科学技术大学附属第一医院(安徽省立医院)接受STN-DBS治疗的38例PD患者。收集患者的年龄、性别、病程、发病年龄及术前及术后随访1年的左旋多巴等效剂量( levodopa equivalent dose,LED)、UPDRS-III、UPDRS-IV、HAMA、HAMD和MMSE评分。比较手术前后的数据差异,同时使用Pearson相关系数检验评估各评分之间的相关性,并对LED变化与UPDRS-IV评分改善进行阈值效应(threshold effect)分析。结果 DBS术后1年,LED平均降低37%;UPDRS-III评分(药物关期)改善48%,UPDRS-III评分(药物开期)改善33%。UPDRS-IV评分改善了63%。HAMA和HAMD评分分别改善9%和未见明显变化。通过阈值效应模型研究发现LED下降与UPDRS-IV评分改善之间存在非线性关系,当LED下降率低于56%时,UPDRS-IV评分改善显著上升。结论 STN-DBS在改善帕金森病患者药物并发症方面显示出显著疗效,并揭示了LED变化与药物并发症改善之间的复杂关系。进一步的研究应探索STN-DBS的具体机制,以提高治疗效果并改善患者的生活质量。

关键词: 脑深部电刺激, 帕金森病, 药物并发症, 临床评分, 左旋多巴

Abstract: Objective This study aims to evaluate the effects of subthalamic nucleus deep brain stimulation (STN-DBS) on drug complications and related clinical scores in patients with Parkinson's disease (PD).Additionally,it seeks to explore the relationship between the improvement of drug complications and other clinical scores (such as anxiety,depression,and cognitive function) in order to gain a deeper understanding of the treatment mechanisms. Methods This study is a retrospective analysis that included 38 Parkinson's disease patients who underwent STN-DBS treatment at the First Affiliated Hospital of the University of Science and Technology of China from September 2019 to June 2020.Data collected included patient age,sex,disease duration,age at onset,and Levodopa Equivalent Dose (LED) before surgery and one year postoperatively,as well as UPDRS-III,UPDRS-IV,HAMA,HAMD,and MMSE scores.Differences between preoperative and postoperative data were compared,and Pearson correlation coefficients were used to assess the relationships between the scores.A threshold effect analysis was conducted to evaluate the association between changes in LED and improvements in UPDRS-IV scores. Results One year after surgery,the average LED decreased by 37%; UPDRS-III scores (off medication) improved by 48%,and UPDRS-III scores (on medication) improved by 33%.UPDRS-IV scores improved by 63%.HAMA and HAMD scores improved by 9% and showed no significant change,respectively.A non-linear relationship was observed between the reduction in LED and the improvement in UPDRS-IV scores,with significant increases in UPDRS-IV improvement occurring when the LED reduction rate was below 56%. Conclusion STN-DBS demonstrates significant efficacy in improving dyskinesia in patients with Parkinson's disease,revealing a complex relationship between changes in LED and improvements in drug complications.Further research should explore the specific mechanisms of STN-DBS to enhance treatment outcomes and improve patients' quality of life.

Key words: Parkinson's disease, Deep brain stimulation, Drug complications, Clinical scores, Levodopa

中图分类号:

R742.5

王晸禹, 熊赤, 陈鹏, 蒋曼丽, 常博文, 贺虎, 牛朝诗. 丘脑底核脑深部电刺激治疗对帕金森病患者药物运动并发症的疗效及其相关临床评分影响[J]. 立体定向和功能性神经外科杂志, 2024, 37(6): 321-325.

Wang Zhengyu, Xiong Chi, Chen Peng, Jiang Manli, Chang Bowen, He Hu.Niu Chaoshi. The effect of STN-DBS treatment on drug-induced motor complications and their associated clinical scores in patients with Parkinson's disease[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(6): 321-325.

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