不同脑内电极植入靶点在帕金森病脑深部刺激术中的应用及安全性评价

Application and Safety Evaluation of Different Intracerebral Electrode Implantation Targets in Deep Brain Stimulation for Parkinson’s Disease

目的探讨不同颅内电极植入靶点在帕金森病(PD)脑深部刺激术(DBS)中的应用及安全性。方法选取80例PD患者为观察对象,根据DBS刺激电极靶点位于丘脑底核(STN)将患者分为STN双侧组(29例)和STN单侧组(25例);另将DBS刺激电极靶点位于苍白球内侧核(GPi)为对照组(26例)。采用统一帕金森病评分量表第3部分(UPDRSⅢ)进行PD症状评价。比较3组患者运动症状评分、认知功能、PD严重程度(H-Y)分级、日常生活能力评分(ADL)变化,以及日平均左旋多巴等效剂量和不良反应情况。结果术后3个月,3组震颤、强直、运动迟缓、UPDRSⅢ评分均下降,且STN双侧组低于STN单侧组和对照组,STN单侧组低于对照组(均P<0.05)。3组执行能力、语言功能评分改善,其中STN双侧组执行能力评分高于STN单侧组和对照组,语言功能评分低于STN单侧组和对照组(P<0.05);STN单侧组与对照组比较差异无统计学意义(P>0.05)。3组外显记忆、内隐记忆和总体认知均无明显变化(P>0.05)。3组ADL评分均升高(P<0.05),但组间两两比较(P>0.05)。左旋多巴等效剂量STN双侧组和STN单侧组显著降低(P<0.05),对照组无明显变化(P>0.05),STN双侧组左旋多巴等效剂量较STN单侧组和对照组降低(P<0.05),STN单侧组左旋多巴等效剂量较对照组降低(P<0.05)。STN双侧组H-Y分级改善(P<0.05),STN单侧组和对照组无改善(P>0.05);3组间术前和术后3个月H-Y分级比较(P>0.05)。不良反应总发生率分别为:STN双侧组(13.79%)、STN单侧组(12.00%)和对照组(7.69%),组间比较(P>0.05)。结论相较于植入单侧STN或GPi刺激电极,植入双侧STN电极行DBS治疗改善PD患者运动症状、认知功能和PD严重程度疗效更好,不良反应少、安全性好,有利于提高患者日常生活能力和减少用药剂量。

Aim To investigate the application and safety of different intracranial electrode implantation targets in deep brain stimulation(DBS) for Parkinson’s disease(PD). Methods Eighty PD patients were selected as the observation objects, and according to the location of the DBS stimulation electrode target in the subthalamus nucleus(STN), the patients were divided into a bilateral STN group(29 cases) and a unilateral STN group(25 cases). In addition, DBS stimulation electrode target located in the medial nucleus of globus pallidus(GPi) was used as the control group(26 cases). The unified Parkinson’s disease rating scale(UPDRS) Ⅲ part 3 was used to evaluate symptoms of PD. The motor symptom score, cognitive function, PD severity(H-Y) grading, daily living ability score(ADL) changes, and the average daily equivalent dose of levodopa and adverse reactions were compared among the three groups. Results Three months after the operation, the tremor, rigidity, bradykinesia, UPDRS Ⅲ score of the three group decreased, and the STN bilateral group is lower than the STN unilateral group and the control group, the STN unilateral group is lower than the control group(all P<0.05). The scores of executive ability and language function were improved in the three groups. The scores of executive ability and language function in the STN bilateral group were higher than those in the STN unilateral group and the control group, while the scores of language function were lower than those in the STN unilateral group and the control group(P<0.05). There was no significant difference between STN unilateral group and the control group(P>0.05). There were no significant changes in explicit memory, implicit memory and general cognition in the 3 groups(P>0.05). ADL scores were all increased in the three groups(P<0.05), but there was no statistically significant difference between the two groups(P>0.05). The equivalent dose of levodopa decreased in both STN and STN unilateral groups(P<0.05), while no significant change was observed in the control group(P>0.05). The equivalent dose of levodopa in STN bilateral group was lower than that in STN unilateral group and the control group(P<0.05), and the equivalent dose of Levodopa in STN unilateral group was lower than that in STN control group(P<0.05). The H-Y grading of STN was improved in the bilateral group(P<0.05), while no improvement was found in the unilateral group of STN and the control group of STN(P>0.05). There was no significant difference between the three groups 3 months before and after the operation(P>0.05). The total incidence of adverse reactions was as follows: bilateral STN group(13.79%), unilateral STN group(12.00%) and the control group(7.69%), without statistically significant difference between the two groups(P>0.05). Conclusion Compared with the implantation of unilateral STN or GPi stimulation electrodes, the implantation of bilateral STN electrodes for DBS therapy can improve the motor symptoms, cognitive function and PD severity of PD patients with better efficacy, fewer adverse reactions and better safety, which is beneficial to improve the patients’ daily life ability and reduce the dose of medication.