丘脑底核脑深部电刺激术治疗帕金森病早期语音声学研究

Acoustic analysis of Parkinsonian speech in the early stage after subthalamic nucleus deep brain stimulation

目的 探讨丘脑底核（STN）脑深部电刺激术（DBS）治疗帕金森病（PD）患者构音障碍的早期疗效.方法 回顾性纳入南京医科大学附属脑科医院神经外科2017年5月至11月行STN-DBS治疗的10例PD患者（PD组）,同时纳入健康志愿者10名（健康对照组）.对未服药状态下的10例PD患者,分别于术后1个月未开机、开机后1个月和开机后3个月,在相对安静的房间录制语音,应用Praat软件分析语音信号并提取3个基频参数,分别为基频均值、基频范围和基频标准差.同时对健康对照组受试者进行语音信号采集和分析.结果 PD患者术后1个月未开机时,语音的基频范围[PD组为（15.5 ±4.8） St、健康对照组为（22.5 ±5.6） St,t=-2.962,P=0.008]和基频标准差[PD组为（2.4±0.7）St、健康对照组为（3.7±0.8）St,t=-4.017,P=0.001]均显著小于健康对照组.PD患者开机后1个月时,语音的3个基频参数与术后1个月未开机时的差异均无统计学意义（均P＞0.05）;开机后3个月时,语音的基频范围[开机后3个月为（19.2 ±3.8）St、术后1个月未开机为（15.5 ±4.8）St,P=0.017]和基频标准差[开机后3个月为（3.2±0.8）St、术后1个月未开机为（2.4±0.7）St,P=0.001]均显著高于术后1个月未开机时,且与健康对照组间3个基频参数的差异均无统计学意义（均P＞0.05）.结论 STN-DBS治疗早期能改善PD患者语音语调单一的特征,缓解患者喉部肌肉及声带僵硬情况.

 Objective To investigate the early efficacy of deep brain stimulation （DBS） of subthalamic nucleus （STN） in the treatment of dysarthria in patients with Parkinson＇s disease （PD）.Methods From May 2017 to November 2017,10 PD patients treated with STN-DBS at Neurosurgery Department affiliated to Nanjing Medical University and 10 healthy volunteers （healthy control group） were recruited retrospectively.Ten PD patients without anti-Parkinson disease medication were recorded in a relatively quiet room at the states of 1 month after operation with stimulation-off,1 month after operation with stimulation-on,and 3 months after stimulation-on.The speech signal was analyzed by Praat software and 3 fundamental frequency parameters were extracted which were the mean fundamental frequency,the range and standard deviation of fundamental frequency.The speech signals from the healthy control subjects were collected and analyzed at the same time.Results The speech fundamental frequency range （PD group：15.5±4.8 St,control group：22.5 ± 5.6 St,t =-2.962,P =0.008） and the standard deviation of fundamental frequency （PD group：2.4 ± 0.7 St,control group：3.7 ± 0.8 St,t =-4.017,P =0.001） in PD group with stimulation-off 1 month post operation were significantly lower than those in healthy control group.There was no significant difference in any parameter of fundamental frequency of the PD patients between the state of 1 month after stimulation-on and the state of 1 month after operation （all P 〉0.05）.At 3 months after stimulation-on,the fundamental frequency range （19.23.8 St,P =0.017） and the fundamental frequency standard deviation （3.20.8 St,P =0.001） of the speech were significantly higher than those at 1 month after operation with stimulation-off,and those was not significant statistical different compared with controls （all P 〉 0.05）.Conclusion Early stage of STN-DBS treatment could improve the phonological tone of PD patients and relieve the stiffness of laryngeal muscles and vocal cord.