帕金森病患者脑深部电刺激术后生活质量改善率的影响因素分析

doi:10.19854/j.cnki.1008-2425.2024.06.0002

摘要/Abstract

摘要： 目的探讨行丘脑底核( subthalamic nucleus,STN )脑深部电刺激术( deep brain stimulation,DBS )的帕金森病(Parkinson ' s disease ,PD)患者术后生活质量的改善效果及影响因素。方法纳入2021年4月至2024年4月于天津市环湖医院神经外科接受STN-DBS手术的原发性帕金森病患者181例,比较术前及术后3个月帕金森患者的生活质量问卷(PDQ-39)评分,并计算其改善率,分为改善率低组及改善率高组。分析性别、年龄、病程、H-Y分期、偏侧性、左旋多巴日等效剂量( levodopa equivalent daily dose,LEDD )、术前PDQ-39评分、术前基线MDS-UPDRS III评分及服药后改善率、术前MoCA和MMSE评分、高血压、糖尿病、脑血管病、快速眼动行为障碍(Rapid Eye Movement Sleep Behavior Disorder,RBD)、体位性低血压对生活质量改善率的影响。结果 1.本研究患者术后3个月PDQ-39评分(33.48±22.26)较术前(58.09±26.02)明显降低(P＜0.001);2.改善率高组的术后PDQ-39评分明显低于改善率低组,改善率高组术前RBD的发生率显著高于改善率低组,差异均具有统计学意义(P＜0.05);3.单因素Logistic回归分析显示,患者术前MoCA、MMSE、RBD是术后生活质量改善率的影响因素;多因素Logistic回归分析显示,患者年龄、术前PDQ-39评分、RBD是术后生活质量改善率的影响因素。结论 :STN-DBS可以显著改善PD患者的生活质量;术前PDQ-39评分、术前认知功能评分(MoCA、MMSE)、RBD为术后生活质量改善的保护因素,年龄为危险因素,临床中应对以上因素进行综合分析及判断,以期使患者得到更好的生活质量。

关键词: 脑深部电刺激术, 帕金森病, 生活质量

Abstract: Objective To explore the improvement effects and influencing factors of quality of life after subthalamic nucleus (STN) deep brain stimulation (DBS) surgery in patients with Parkinson's disease (PD). Methods A total of 181 primary PD patients who underwent STN-DBS surgery at the Neurosurgery Department of Huanhu Hospital in Tianjin from April 2021 to April 2024 were included.The Parkinson's Disease Quality of Life Questionnaire (PDQ-39) scores before and three months after surgery were compared,and the improvement rate was calculated,dividing the patients into a low improvement rate group and a high improvement rate group.The influence of gender,age,disease duration,H-Y staging,laterality,levodopa equivalent daily dose (LEDD),preoperative PDQ-39 scores,preoperative baseline MDS-UPDRS III scores and improvement rate after medication,preoperative MoCA and MMSE scores,hypertension,diabetes,cerebrovascular disease,rapid eye movement sleep behavior disorder (RBD),and orthostatic hypotension on the improvement rate of quality of life was analyzed. Results 1.The PDQ-39 scores of the patients three months after surgery (33.48±22.26) were significantly lower than before surgery (58.09±26.02) (P＜0.001);2.The postoperative PDQ-39 scores of the high improvement rate group were significantly lower than those of the low improvement rate group,and the incidence of RBD before surgery in the high improvement rate group was significantly higher than in the low improvement rate group,with both differences being statistically significant (P＜0.05);3.Univariate Logistic regression analysis showed that preoperative MoCA,MMSE,and RBD were influencing factors of the postoperative quality of life improvement rate;multivariate Logistic regression analysis showed that patient age,preoperative PDQ-39 score,and RBD were influencing factors of the postoperative quality of life improvement rate. Conclusion STN-DBS can significantly improve the quality of life of PD patients;preoperative PDQ-39 score,preoperative cognitive function scores (MoCA,MMSE),and RBD are protective factors for postoperative quality of life improvement,while age is a risk factor.A comprehensive analysis and judgment of the above factors should be made in the clinic to achieve better quality of life.

Key words: Deep Brain Stimulation, Parkinson's Disease, Quality of Life

中图分类号:

R742.5

王琦, 李海涛, 吴静超, 于洋, 梁思泉. 帕金森病患者脑深部电刺激术后生活质量改善率的影响因素分析[J]. 立体定向和功能性神经外科杂志, 2024, 37(6): 326-331.

Wang Qi, Li Haitao, Wu Jingchao, Yu Yang, Liang Siquan. Analysis of factors affecting the improvement rate of quality of life after deep brain stimulation surgery in Parkinson's disease patients.[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2024, 37(6): 326-331.

参考文献

[1] Opara J.Current possibilities of evaluation of quality of life in Parkinson disease[J].Neurol Neurochir Pol,2003,37(3):241~250.
[2] Krack P,Batir A,Van Blercom N,et al.Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease[J].N.Engl.J.Med,2003,349(20):1925~1934.
[3] Deuschl G,Schade-Brittinger C,Krack P,et al.A randomized trial of deep-brain stimulation for Parkinson’s disease[J].N.Engl.J.Med,2006,355(9):896-908.
[4] Schuepbach WMM,Tonder L,Schnitzler A D,et al.Quality of life predicts outcome of deep brain stimulation in early Parkinson disease[J].Neurology,2019,92(10):e1109~e1120.
[5] Dafsari HS,RektorI K,Mahlstedt P,et al.Beneficial effects of bilateral subthalamic stimulation on alexithymia in Parkinson’s disease[J].Eur.J.Neurol,2019,26(2):222~e217.
[6] Irmen F,Horn A,Mosley P,et al.Left prefrontal connectivity links subthalamic stimulation with depressive symptoms[J].Ann.Neurol,2020,87(6):962~975.
[7] Daniels C,Krack P,Volkmann J,et al.Is improvement in the quality of life after subthalamic nucleus stimulation in Parkinson’s disease predictable [J].Mov.Disord,2011,26(14):2516-2521.
[8] Williams A,Gill S,Varma T,et al.Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson’s disease (PD SURG trial):a randomised,open-label trial[J].Lancet Neurol,2010,9(6):581~591.
[9] Jost S T,Rizos A,Loehrer PA,et al.A prospective,controlled study of non-motor effects of subthalamic stimulation in Parkinson’s disease:results at the 36-month follow-up[J].J.Neurol.Neurosurg.Psychiatry,2020,91(7):687~694.
[10] Floden D,Busch RM,Cooper SE,et al.Global cognitive scores do not predict outcome after subthalamic nucleus deep brain stimulation[J].Mov Disord,2015,30(9):1279~1283.
[11] Jost ST,Visser-Vandewalle V,Rizos A,et al.Non-motor predictors of 36-month quality of life after subthalamic stimulation in Parkinson disease[J].NPJ Parkinson’s Dis,2021,7(1):48[12] Siderowf A,Jaggi JL,Xie SX,et al.Long-term effects of bilateral subthalamic nucleus stimulation on health-related quality of life in advanced Parkinson’s disease[J].Mov.Disord,2006,21(6):746~753.
[13] Chandran S,councillor S,Rao RM,et al.Gender influence on selection and outcome of deep brain stimulation for Parkinson’s disease[J].Ann.Indian Acad.Neurol,2014,17(1):66~70.
[14] Lezcano E,Gómez-Esteban JC,Tijero B,et al.Long-term impact on quality of life of subthalamic nucleus stimulation in Parkinson’s disease[J].J Neurol,2016,263(5):895~905.
[15] 孟凡刚,陈玲,刘钰晔,等.中国帕金森病脑深部电刺激疗法专家共识(第二版)解读[J].中华神经外科杂志,2021,37(5):439~442.
[16] Semmler C,Stopic V,Jost ST,et al.Preoperative motor deficits and depressive symptoms predict quality of life in patients with Parkinson's disease at different time points after surgery for subthalamic stimulation:a retrospective study[J].Neurol Res Pract,2024,6(1):8.
[17] Morishita T,Rahman M,Foote KD,et al.DBS candidates that fall short on a levodopa challenge test:alternative and important indications[J].Neurologist,2011,17(5):263~268.
[18] Floden D,Cooper SE,Griffith SD,et al.Predicting quality of life outcomes after subthalamic nucleus deep brain stimulation[J].Neurology,2014,83(18):1627~1633.
[19] Witt K,Daniels C,Krack P,et al.Negative impact of borderline global cognitive scores on quality of life after subthalamic nucleus stimulation in Parkinson’s disease[J].J.Neurol,Sci,2011,310(1-2):261~266.
[20] 中华医学会神经病学分会帕金森病及运动障碍学组,中国医师协会神经内科医师分会帕金森病及运动障碍学组.中国帕金森病睡眠障碍管理专家共识[J].中华神经科杂志,2022,55(5):441~451.