STN-DBS治疗左旋多巴冲击试验改善率较低的原发性帕金森病患者的短期疗效

Short-term efficacy analysis of STN-DBS for Parkinson′s disease in patients with low improvement rate in levodopa challenge test

目的探讨丘脑底核脑深部电刺激术(STN-DBS)治疗左旋多巴冲击试验(LCT)改善率<30%的原发性帕金森病(PD)患者的短期疗效。方法回顾性分析2015年3月至2017年12月在海军军医大学附属长海医院神经外科应用STN-DBS治疗的35例LCT改善率<30%的原发性PD患者的临床资料。术前根据PD运动分型将患者分为震颤为主型(12例)、姿势不稳/步态障碍型(17例)、混合型(6例)。分别比较3组类型PD患者间的术前LCT改善率、STN-DBS术后开机未服药时的运动症状评分改善率(简称术后运动症状改善率)。比较术前LCT改善率与STN-DBS术后1个月时患者的运动症状改善率,并对其进行分析。结果震颤为主型、姿势不稳/步态障碍型及混合型PD患者的术前LCT改善率分别为(19.38±6.85)%、(23.76±5.02)%及(16.48±10.00)%,3组比较差异无统计学意义(F=2.31,P=0.12);3组类型患者术后运动症状改善率分别为(51.75±8.65)%、(41.52±13.11)%及(38.90±14.15)%,3组比较差异有统计学意义(F=3.39,P=0.04)。35例PD患者的术后运动症状改善率较术前LCT改善率有明显提高(t=9.46,P<0.01)。3组类型患者术后运动症状改善率均明显高于术前LCT改善率(均P<0.01);3组类型患者的STN-DBS术后运动症状改善率较术前LCT改善率的提高程度差异有统计学意义(F=4.12,P=0.03),震颤为主型与姿势不稳/步态障碍型比较差异有统计学意义(P=0.02)。结论STN-DBS对LCT改善率<30%的原发性PD患者的运动症状改善有效,尤其对震颤为主型的原发性PD患者的短期疗效更佳。

Objective To investigate the short-term efficacy of STN-DBS(subthalamic nucleus-deep brain stimulation)in patients with Parkinson′s disease and an improvement rate of<30%in levodopa challenge test(LCT).Methods A retrospective analysis was conducted on the clinical data of 35 patients with Parkinson′s disease and an improvement rate of<30%in LCT who underwent STN-DBS from March 2015 to December 2017 at Department of Neurosurgery,Changhai Hospital Affiliated to Navy Medical University.All those patients were divided into tremor dominant(TD)type(n=12),postural instability/gait disturbance(PIGD)type(n=17)and indeterminate type(n=6)according to the motor symptoms of Parkinson′s disease.The preoperative LCT improvement rate and the improvement rate of motor symptoms in an on-stimulation off-medication state(referred to as the postoperative improvement rate of motor movement symptoms)were compared in 3 groups of patients.Comparison and analysis were conducted on the improvement rate of LCT before surgery and the improvement rate of motor symptoms at 1 month post STN-DBS.Results The improvement rates in LCT of TD,PIGD and indeterminate types of patients prior to operation were(19.38±6.85)%,(23.76±5.02)%and(16.48±10.00)%respectively.There was no statistical difference among the 3 groups(F=2.31,P=0.12).The postoperative improvement rates of motor symptoms in those 3 types were(51.75±8.65)%,(41.52±13.11)%and(38.90±14.15)%respectively.There was significant difference among the groups(F=3.39,P=0.04).The postoperative improvement rate of motor symptoms was significantly higher than the improvement rate in preoperative LCT in 35 patients(t=9.46,P<0.01)and in subgroup aualysis(P<0.01 respectively).The elevation from preoperative improvement rate in LCT to post-DBS improvement rate of motor symptoms in 3 groups of patients was statistically significant(F=4.12,P=0.03),and the difference between TD and PIGD types was statistically significant(P=0.02).Conclusion STN-DBS seems effective for improving the motor symptoms of Parkinson′s disease patients with LCT<30%,particularly in TD types in terms of short-term outcome.