丘脑底核脑深部电刺激对帕金森病焦虑状况的影响

Effects of subthalamic nucleus-deep brain stimulation on anxiety in Parkinson disease

目的探讨双侧丘脑底核脑深部电刺激(STN-DBS)对帕金森病人焦虑状况的影响。方法设置双侧STN-DBS组及左旋多巴类药物治疗组,配对入组,每组有效病例各31例。采用汉密尔顿焦虑量表(HAMA)、焦虑状态-特质问卷(STAI)、帕金森病生活质量39问卷(PDQ-39)及统一帕金森病评定量表第Ⅲ部分(UPDRS-Ⅲ)对病人进行评估分析。结果与术前及药物治疗组相比,STN-DBS组术后状态焦虑(S-AI)评分明显降低(均P<0.05)。STN-DBS组UPDRS-Ⅲ评分与S-AI评分在术后4个月内相关(均P<0.05),电压、脉宽与特质焦虑(T-AI)和HAMA评分均相关(均P<0.05);术后电压和脉宽对T-AI和HAMA评分的标准回归方程成立,回归系数均显著(均P<0.05)。结论 STN-DBS在改善帕金森病人运动障碍的同时,在短期内可改善即时焦虑情绪。在治疗范围内,STN-DBS电压和脉宽越高,帕金森病人的特质焦虑情绪和焦虑症状越严重。

Objective To study the effects of bilateral subthalamic nucleus-deep brain stimulation(STN-DBS) on anxiety status in Parkinson disease(PD).Methods Sixty-two PD patients were assigned into bilateral STN-DBS group and L-dopa drug therapy group,31 each,for paired study.The patients were evaluated by Hamilton depression scale(HAMA),state-trait anxiety inventory(STAI),Parkinson's disease questionnaire-39(PDQ-39) and the unified Parkinson disease rating scale Ⅲ(UPDRS-Ⅲ).Results Compared with the preoperative value and the drug therapy group,the state anxiety(S-AI) scores of the STN-DBS group were decreased notably(P<0.05).UPDRS-Ⅲ scores of the STN-DBS group were significantly correlated with S-AI scores within 4 months postoperatively(all P<0.05).The voltage and pulse width of the STN-DBS group were obviously correlated with trait anxiety(T-AI) scores and HAMA scores(all P<0.05).Standard regression equations between the voltage,pulse width and T-AI,HAMA scores were established and all the regression coefficients were significant(all P<0.05).Conclusions The STN-DNS improves not only motor symptoms but also instant anxiety in short-term in PD patients.Within the treatment range,the voltage and pulse width of STN-DBS are higher,the trait anxiety and anxiety symptom in PD patients are more severe.