丘脑底核-脑深部刺激术治疗帕金森病相关疼痛的疗效分析

Clinical efficacy analysis on subthalamic nucleus deep brain stimulation for Parkinson's disease related pain

目的探讨丘脑底核-脑深部刺激术(STN-DBS)治疗帕金森病(PD)相关疼痛的疗效,以及疼痛与焦虑抑郁的相关性。方法对淮安市第二人民医院及南京医科大学附属脑科医院2018年1月—2019年12月,行双侧STN-DBS治疗的存在疼痛症状的43例中晚期PD患者的临床资料进行回顾分析。所有患者术后1个月开机并随访6个月,采用视觉模拟评分(VAS)法评价患者疼痛程度,汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评价焦虑抑郁症状。总结STN-DBS治疗PD相关疼痛的疗效,分析疼痛与焦虑抑郁的相关性。结果本组患者中,28例患者(65.1%)存在疼痛微毁损效应。开机后6个月时,41例患者(95.3%)的疼痛症状减轻,VAS评分为(1.19±1.47)分,显著低于术前的(3.51±1.84)分(P<0.05),平均改善为66.1%。患者术后HAMA、HAMD评分分别为(13.16±4.52)分和(15.35±4.19)分,显著低于术前的(17.21±5.47)分和(21.60±4.82)分(均P<0.05)。VAS评分与HAMA、HAMD评分均呈正相关(r=0.664,r=0.505,均P<0.001)。结论中晚期PD患者的疼痛症状与焦虑抑郁有显著关系;STN-DBS治疗可有效改善其疼痛症状,并且多数患者存在疼痛微毁损效应。

Objective To summarize and analyze the clinical efficacy of subthalamic nucleus deep brain stimulation(STN-DBS)in the treatment of Parkinson's disease(PD)related pain and to analyze the correlation between pain and anxiety/depression.Methods The clinical data of 43 patients with advanced PD who underwent STN-DBS treatment in the Second People's Hospital of Huaian City and Nanjing Brain Hospital from January 2018 to December 2019 were analyzed retrospectively.All patients started up 1 month after operation and followed up for 6 months.The visual analogue scale(VAS)was used to evaluate the degree of pain.Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)were used to evaluate anxiety and depression symptoms.The efficacy of STN-DBS in the treatment of PD related pain,and the correlation between pain and anxiety/depression were summarized.Results The electrode position was accurate in 43 patients with PD,there were 28(65.12%)had microlesion effect(MLE)of pain,41(95.35%)had pain relief at 6 months postoperatively,VAS score was(1.19±1.47),significantly lower than baseline of(3.51±1.84)(P<0.05),with an average improvement of 66.10%.The postoperative HAMA and HAMD scores were(13.16±4.52)and(15.35±4.19),which were significantly lower than those before operation(17.21±5.47)and(21.60±4.82)(P<0.05),the correlation coefficients of HAMA,HAMD and VAS scores were 0.664(P<0.001),0.505(P<0.001).Conclusion Pain in patients with advanced PD is significantly related to anxiety and depression,STN-DBS can effectively alleviate the symptoms of PD related pain,and most of them have MLE of pain.