丘脑底核电刺激术治疗帕金森病的疗效

Efficacy analysis of subthalamic nucleus-deep brain stimulation for Parkinson's disease

目的评估丘脑底核脑深部电刺激(STN-DBS)对帕金森病的临床疗效。方法回顾性分析应用STN-DBS手术治疗的32例帕金森病病人的临床资料,在术前、术后3个月分别采用统一帕金森病评定量表(UPDRS)、抑郁自评量表(SDS)和症状自评量表(SCL-90)进行随访评估、心理状况问卷调查和分析。结果脉冲发生器开启后,32例病人的UPDRS日常活动和运动功能在"关"状态,平均改善率为51.7%和60.9%;在"开"状态下,平均改善率21.4%和22.3%。20例病人术前SDS评分>50分,其SCL-90的抑郁、焦虑、躯体化、人际敏感、敌对、恐怖和偏执7个因子显著高于中国常模(P<0.05)。术前与术后SCL-90抑郁、躯体化、恐怖、焦虑、精神病性因子有显著性差异(P<0.05),人际敏感、偏执、敌对和强迫等因子无显著性差异(P>0.05)。结论 STN-DBS可以改善帕金森病病人的运动功能,提高日常生活能力,还可以明显改善帕金森病伴抑郁病人的心理状况,是安全有效的治疗方法。

Objective To assess the clinical efficacy of subthalamic nucleus-deep brain stimulation（ STN-DBS） for Parkinson＇s disease.Methods Clinical data of 32 Parkinson＇s disease patients undergoing STN-DBS were analyzed retrospectively.The unified Parkinson＇s disease rating scale（UPDRS）,self-rating depression scale（SDS） and the symptom checklist（SCL-90） were scored for follow-up assessment,mental status questionnaire and analysis before and 3 months after surgery.Results After the opening of pulse generator,daily living activities and motor function in UPDRS of 32 patients were in the ＇off＇ state and the average improvement rate was 51.7% and 60.9% respectively,while in the ＇on＇ state,the average improvement rate was 21.4% and 22.3% respectively.There were 20 patients whose preoperative SDS scores were more than 50 points and whose seven factors in SCL-90 including depression,anxiety,somatization,interpersonal sensitivity,hostility,fear and paranoia were significantly higher than the Chinese norm（P〈0.05）.Comparing the postoperative depression,somatization,fear,anxiety and psychosis factor to preoperative,those showed a significant difference（P〈0.05）,while interpersonal sensitivity,paranoia,hostility and obsession showed no significant difference（P〉0.05）.Conclusions STN-DBS can not only improve motor function and daily living skills of Parkinson＇s disease patients,but also significantly improve mental status of patients with depressive disorder,therefore,being a safe and effective method.