帕金森病脑深部电刺激术评估队列手术治疗相关因素分析

Factors of surgical selection in the evaluation cohort of deep brain stimulation in Parkinson’s disease

目的探讨帕金森病脑深部电刺激手术评估队列患者手术治疗的相关影响因素及未手术原因。方法选择就诊于2个临床中心因拟行脑深部电刺激术进行术前评估患者共406例,根据评估后是否进行手术分组,手术组302例,未手术组104例。对比两组患者的人口学特征、临床特征和量表评价结果,分析患者基线特征与手术的相关性,总结分析患者未能采用手术治疗的可能影响因素。结果对比基线特征,未手术患者具有更高的发病年龄、更长的病程、双侧起病、认知状况更差、平衡功能更差、Hoehn-Yahr分期更高和生活质量更差。诊断问题是未手术患者的最主要原因(占44.2%),其次是药物反应不佳(占15.4%),手术意愿以及手术期望值不符分别占9.6%和6.7%。结论诊断是决策患者手术的最主要原因。此外,起病侧别、发病年龄、病程、认知状况、平衡功能、生活质量、开期的运动症状和运动并发症可能成为手术决策的考虑因素。

Objective To investigate the related factors of surgical treatment and the reasons for non-operation in the evaluation cohort of deep brain stimulation.Methods A total of 406 patients who undergo DBS preoperative evaluation were selected from two clinical centers.According to whether the patients were operated or not,the patients were divided into operation group(n=302)and non-operation group(n=104).Demographic characteristics,clinical characteristics and scale evaluation results of the two groups were compared.The correlation information between baseline characteristics and surgery was analyzed,and the reasons for non-operation were summarized.Results Compared with baseline data,none operation group had higher age of onset,longer course of disease,bilateral onset,poorer cognitive status,poorer balance function,higher Hoehn Yahr stage,worse QOL,and worse balance function.Diagnostic problems were the main reasons of non-operation(44.2%),followed by poor levodopa response(15.4%),the operation intention(9.6%)and the operation expectation of patients(6.7%).Conclusion By comparing the baseline clinical characteristics of patients who underwent surgery and those who did not,it was found that the side of onset,age of onset,disease duration,cognitive status,balance function,QOL,motor symptoms and motor complications may be considered in surgical decision-making.Diagnostic problems were the main reasons for non-operation(44.2%).