丘脑底核深部电刺激治疗帕金森病效果Meta分析

EFFICACY OF DEEP BRAIN STIMULATION OF THE SUBTHALAMIC NUCLEUS IN PARKINSON DISEASE:A META ANALYSIS

目的评价双侧丘脑底核深部电刺激(STN-DBS)治疗帕金森病的有效性和安全性。方法于Pubmed、Cochrane Library、EMbase、SCI、Medline、CNKI、CBM文献数据库中检索2015年4月以前发表的STNDBS治疗帕金森病的临床试验研究,收集帕金森病病人术前和术后1年的帕金森病统一评分量表(UPDRS)数据,利用StataSE 12.0软件进行系统评价。结果纳入14项临床研究共450例病人。在日常生活活动、语言和步态方面,术前药物治疗优于术后单纯STN-DBS;在运动功能、震颤、强直和姿势稳定性方面,术后STN-DBS联合药物治疗优于术前药物治疗。STN-DBS治疗1年后,左旋多巴剂量降低了47.2%,治疗副作用评分降低了72%。由刺激所致的并发症较常见,但是大多数不良反应持续时间短暂,经过调节刺激参数可以改善。结论 STN-DBS可改善帕金森病病人运动波动症状和临床运动功能障碍,且不良反应少,安全性高。

Objective To assess the efficacy and safety of bilateral subthalamic nucleus deep brain stimulation （STNDBS） in Parkinson＇s disease. Methods Papers on Parkinson＇s disease treated with STN-DBS published before April 2015- were searched from Pubmed, Coehrane Lihrary, EMhase, SCI, Medline, CNKI and CBM databases. The data of the Unified Parkinson＇s Disease Rating Scale （UPDRS） of before surgery and one year after surgery were collected and a system evaluation was conducted using StataSE 12.0 software. Results A total of 450 patients were brought into 14 items of clinical research. On activities of daily living, speech and gait, pre-operative medication was better than post operative simple STN-DBS; on motor function, tremor, rigidity and postural stability, post operative STN-DBS combined with medication was better than pre-operative medication. After one-year STN-DBS therapy, the dosage of Levodopa decreased by 47.2% and side-effect score lowered by 72%. Complications due to stimulation were more commonly seen, but the duration of adverse reactions was short, which could be im- proved through mediating stimulation parameters. Conclusion STN-DBS can improve motor fluctuation and clinical motor dysfunction in patients with Parkinson＇s disease, this therapy is of less adverse reactions and high safety.