摘要
目的 研究帕金森病丘脑底核脑深部电刺激器(subthalamic nucleus-deep brain stimulation,STN-DBS)术中电极融合误差与抑郁改善关联性。方法 前瞻性选取2020年1月至2022年12月于海南省人民医院神经外科进行STN-DBS治疗的帕金森病患者240例,根据不同治疗效果分为有效组211例,无效组29例。所有患者均采取STN-DBS术进行治疗,分别比较不同疗效、不同心理状况以及不同认知状况患者的电极融合误差情况,研究STN-DBS术中电极融合误差与抑郁改善、认知改善的相关性。结果 有效组与无效组性别、年龄、体质量指数、高血压、糖尿病、高脂血症、病程、术前简易智能状态检查量表(mini-mental state examination,MMSE)、术前39项帕金森病生活质量问卷评分比较,差异无统计学意义(P>0.05)。与术前的冲击试验治疗比较,STN-DBS治疗后震颤、僵直、运动迟缓、统一帕金森病评分量表Ⅲ改善率显著升高,差异有统计学意义(P<0.01)。2组治疗前焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)、蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)、MMSE、阿尔茨海默病评定量表-认知分量表(Alzheimer's disease assessment scale cognitive subscale,ADAS-Cog)、中医证候变化总体印象量表(Chinese medicine syndrome change overall impression scale,CGIC-S)评分比较,差异无统计学意义(P>0.05)。2组治疗后SAS、SDS、CGIC-S评分、ADAS-Cog评分较治疗前降低(P<0.01);有效组SAS、SDS、CGIC-S评分、ADAS-Cog评分低于无效组(P<0.01);2组治疗后MoCA、MMSE评分较治疗前升高(P<0.01);有效组MoCA、MMSE评分高于无效组(P<0.01)。SDS评分≥53分、SAS评分≥50分的患者左侧和右侧靶点坐标偏差显著高于SDS评分<53分以及SAS评分<50分的患者(P<0.01)。MoCA评分<26分、MMSE评分<27分、ADAS-Cog评分≥36分、CGIC-S评分>1分患者的左侧和右侧靶点坐标偏差显著高于MoCA评分≥26分、MMSE评分≥27分、ADAS-Cog评分<36分、CGIC-S评分≤1分患者(P<0.01)。相关性分析显示,患者的两侧融合误差与MoCA、MMSE评分呈负相关(r=-0.678,P<0.01;r=-0.653,P<0.01;r=-0.448,P<0.01;r=-0.704,P<0.01),与ADAS-Cog、CGIC-S、SDS、SAS评分呈正相关(r=0.586,P<0.01;r=0.501,P<0.01;r=0.572,P<0.01;r=0.601,P<0.01;r=0.742,P<0.01;r=0.667,P<0.01;r=0.463,P<0.01;r=0.381,P<0.01)。结论 在对帕金森患者的治疗中,STN-DBS术中电极融合误差与抑郁改善、认知评分呈现显著的相关性,可以作为临床治疗效果预测的重要依据之一。未来临床可以根据术中的误差情况,及时有效对患者开展辅助性治疗,进一步指导临床治疗。
Objective To investigate the association between electrode fusion error and improvement of depression during subthalamic nucleus-deep brain stimulation(STN-DBS) surgery for Parkinson’s disease(PD).Methods A prospective trial was conducted on 240 PD patients undergoing STN-DBS treatment in our hospital from January 2020 to December 2022.According to their clinical outcomes,they were divided into effective group(211 cases) and ineffective group(29 cases).The electrode fusion error was compared among the patients with different efficacy,psychological status,and cognitive status to analyze the correlation of electrode fusion error during STN-DBS surgery with improvement of depression and cognition.Results There were no significant differences between the effective group and ineffective group in terms of gender,age,body mass index,hypertension,diabetes,hyperlipidemia,disease duration,or preoperative MMSE and PDQ-39 scores(P>0.05).STN-DBS treatment resulted in obviously improved clinical symptoms such as tremor,rigidity and bradykinesia,and higher UPDRSⅢ score when compared with the results of preoperative impact test(P<0.01).Before treatment,no statistical differences were observed in the scores of SAS,SDS,MoCA,MMSE,Alzheimer’s disease assessment scale cognitive subscale(ADAS-Cog) or Chinese medicine syndrome change overall impression scale(CGIC-S) between the effective and ineffective groups(P>0.05).After treatment,the scores of SAS,SDS,CGIC-S and ADAS-Cog were declined(P<0.01),and these four scores was notably lower in the effective than the ineffective groups(P<0.01).The scores of MoCA and MMSE were significantly elevated in both groups after surgery(P<0.01),and the scores were higher in the effective group than the ineffective group(P<0.01).The target coordinate deviation on the left and right was significantly higher in the patients with SDS≥53 and SAS≥50 than those of SDS<53 and SAS<50(P<0.01).The target coordinate deviation on the left and right of the patients with MoCA<26,MMSE<27,ADAS-Cog≥36 and CGIC-S>1 was statistically higher than that of the patients with MoCA≥26,MMSE≥27,ADAS-Cog<36 and CGIC-S≤1(P<0.01).Correlation analysis displayed that the bilateral fusion error of patients was negatively correlated with MoCA and MMSE scores(r=-0.678,P<0.01;r=-0.653,P<0.01;r=-0.448,P<0.01;r=-0.704,P<0.01),and positively with ADAS-Cog,CGIC-S,SDS and SAS scores(r=0.586,P<0.01;r=0.501,P<0.01;r=0.572,P<0.01;r=0.601,P<0.01;r=0.742,P<0.01;r=0.667,P<0.01;r=0.463,P<0.01;r=0.381,P<0.01).Conclusion In PD treatment,electrode fusion error during STN-DBS is significantly correlated with improvement of depression and cognitive score,which can be used as one of the important evidence for predicting clinical effectiveness.In the future,according to the intraoperative error,auxiliary treatment can be carried out timely and effectively to guide further clinical treatment.
作者
李俊驹
李庆志
胡佳豪
莫斌
Li Junju;Li Qingzhi;Hu Jiahao;Mo Bin(Department of Neurosurgery,Hainan General Hospital,Haikou 570311,Hainan Province,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2024年第10期1167-1172,共6页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
海南省自然科学基金高层次人才项目(821RC682)。
关键词
帕金森病
丘脑底核
电刺激
左旋多巴
Parkinson disease
subthalamic nucleus
electric stimulation
levodopa
