双侧丘脑底核电刺激对帕金森病患者抑郁状况的影响

Effects of Bilateral Deep Brain Stimulation of the Subthalamic Nucleus on Depression in Patients with Parkinson's Disease.

目的探讨双侧丘脑底核脑深部电刺激对帕金森病患者抑郁状况的影响。方法设置STN-DBS组及药物治疗对照组,配对入组,有效病例27对。两组患者均只服用左旋多巴制剂且剂量前后无显著变化,均未服用抗抑郁药物。前后共6次分别评估其抑郁及运动状况。结果与术前及药物治疗组相比,STN-DBS组术后运动功能改善,抑郁状况短期内(3～6个月)改善;STN-DBS组术后运动评分与抑郁评分短期内(5周～6个月)相关,双侧电压均值与其抑郁评分均相关;STN-DBS组术后电压均值对抑郁评分的标准回归方程及回归系数均显著,运动评分对抑郁评分的标准回归方程及回归系数在短期内(5周～3个月)显著。结论STN-DBS对PD患者运动障碍症状的改善在短期内可改善其抑郁状况,但长期效应不明显。在STN-DBS治疗电压值范围内,双侧电压均值越高,PD患者的抑郁状况越严重。

Objective To study the long-term effects of deep brain stimulation （DBS） of the bilateral subthalamic nucleus （STN） on depression in patients with Parkinson＇s disease （PD） and explore the underlying mechanisms. Methods Twenty-seven patients with Parkinson＇s diseases were included in a paired design study. The patients were randomly divided into STN-DBS and anti-Parkinson＇s medication control groups. The patients in both groups only took the constant dose of levodopa, but not the antidepressant drugs during the evaluation period. The Evaluation of the depression and motor function were performed six times in total. Results Compared with the preoperative and the medication control group, the sport scores of the STN-DBS group decreased remarkably. The depression scores decreased notably within 3 months to 6 months. The sport scores of the STN-DBS group were strongly correlated with their depression scores within 5 weeks to 6 months. The mean value of the bilateral voltages of the STN-DBS group was obviously correlated with depression scores. Standard regression equations and coefficients between the sport scores and the depression scores of the STN-DBS group were obviously significant within 5 weeks to 3 months. Standard regression equations and coefficients between the mean value of bilateral voltages and the depression scores of the STN-DBS group were obviously significant. Conclusions Bilateral STN-DNS improves not only motor symptoms but also short term depression in PD patients. When the bilateral voltages are within the treatment range, the higher the mean value of bilateral voltages, the more severe the depression in PD patients.