急性阶梯式左旋多巴试验预测脑深部电刺激术治疗帕金森病疗效的前瞻性研究

Acute Stepwise Levodopa Test Predicting Outcome of Deep Brain Stimulation for Parkinson's Disease

目的评价急性阶梯式左旋多巴试验对脑深部电刺激术治疗帕金森病疗效的预测价值。方法65例帕金森病患者在筛选过程中进行了急性阶梯式左旋多巴负荷试验(左旋多巴/苄丝肼剂量依次为100/25 mg、150/37.5 mg、200/50 mg和300/75mg),然后接受双侧丘脑底核-脑深部电刺激器(STN-DBS)植入术,随访24个月。将急性左旋多巴负荷试验的结果与24个月后的脑深部电刺激术疗效进行对照和一致性检验。结果给予左旋多巴/苄丝肼150/37.5 mg、200/50 mg和300/75 mg的试验结果与STN-DBS疗效的一致性高,Kappa值依次为0.373、0.642和0.849(P<0.01)。给予左旋多巴/苄丝肼100/25 mg进行试验结果与STN-DBS疗效的一致性低,Kappa值为0.221(P>0.05)。结论急性阶梯式左旋多巴负荷试验可以准确预测脑深部电刺激术治疗帕金森病的远期疗效,可以用于筛选适合脑深部电刺激术治疗的帕金森病患者。

Objective To assess the predictive value of acute stepwise levodopa challenge test on the outcome of deep brain stimulation in patients with Parkinson＇s disease （PD）. Methods 65 patients with PD underwent acute stepwise challenge test with orai levodopa/benserazide 100/25 mg, 150/37.5 mg, 200/50 mg and 300/75mg respectively. And then they were implanted bilateral deep brain stimulation （DBS）. The concordance between the results of acute levodopa challenge test and the outcome of DBS were evaluated after 24 months of follow-up. Results The result of the tests with levodopa/benserazide 150/37.5 mg, 200/50 mg and 300/ 75 mg showed statistically significant concordance with the outcomes of DBS, with Kappa value being 0. 373, 0. 642 and 0. 849 respectively （P〈0.01）. But the result of the test with levodopa/benserazide 100/25 mg did not showed significant concordance with the outcomes of DBS, with Kappa value being 0. 221 （P〉0. 05）. Conclusion The new acute stepwise levedopa challenge test could predict the outcome of DBS and should be used as a tool for screening appropriate candidates for DBS.