帕金森病患者脑深部电刺激术后总输出电能变化及相关因素分析

Analysis of changes and relevent factors for total electrical energy delivered after deep brain stimulation in patients with Parkinson’s disease

目的探讨PD患者在双侧丘脑底核脑深部电刺激术(DBS)后1年两侧平均总输出电能(TEED)变化及其相关因素。方法纳入北京医院双侧丘脑底核DBS后PD患者42例,收集术前临床资料,包括性别、年龄、病程、量表评估包括“关”期统一PD评定量表第三部分(UPDRSⅢ)、基于运动的PD亚型、术前“关”期Hoehn-Yahr(H-Y)分期、左旋多巴等效剂量、术前左旋多巴负荷试验改善率等。在术后1个月开机时、术后3个月、术后6个月、术后1年分别随访,记录程控参数变化并计算两侧TEED。相关因素用多元线性回归进行分析。结果术后UPDRSⅢ评分较术前“关”期平均改善率(54.40±16.51)%,左旋多巴等效剂量较术前平均减少(37.71±27.48)%。STN-DBS术后1年内,随着时间的增加左右两侧的电压、TEED及左脑脉宽逐渐增加,差异有统计学意义(均P<0.05)。不同临床亚型间左脑电压、左脑TEED、右脑电压、右脑脉宽、右脑TEED及频率均存在明显差异(均P<0.05)。不同“关”期H-Y分期患者左脑电压、左脑脉宽、左脑阻抗、右脑电压、右脑TEED差异有统计学意义(均P<0.05)。左脑TEED与年龄呈负相关(t=-3.204,95%CI:-1.644~-0.364,P=0.003),与DBS术后时间呈正相关(t=2.716,95%CI:0.400~2.825,P=0.011);右脑TEED与左旋多巴冲击试验改善率呈负相关(t=-2.114,95%CI:-0.504~-0.009,P=0.043),DBS术后时间呈正相关(t=2.260,95%CI:0.124~2.446,P=0.031)。结论PD患者接受双侧丘脑底核DBS后1年双侧电压和TEED随时间逐渐增加,而频率和脉宽、阻抗的变化较小。不同临床亚型、不同“关”期H-Y分期的患者的TEED和电压等存在明显差异。双侧丘脑底核DBS术后双侧TEED与年龄、术前左旋多巴冲击试验改善率、DBS术后时间相关。

Objective To investigate the changes of the total electrical energy delivered(TEED)of both sides and its related factors within 1 year after bilateral subthalamic nucleus deep brain stimulation(STN⁃DBS)in patients with Parkinson’s disease(PD).Methods A total of 42 patients with PD after STN⁃DBS in Beijing Hospital were included.Preoperative clinical data were collected,including gender,age,course of disease,Unified PD Rating ScaleⅢ(UPDRSⅢ)in“off”stage,exercise⁃based PD subtype,preoperative Hoehn⁃Yahr(H⁃Y)staging in“off”stage,levodopa equivalent dose and preoperative levodopa load test improvement rate.Follow⁃up was performed at 1 month after operation,3 months after operation,6 months after operation,and 1 year after operation to record the changes of program⁃controlled parameters and calculate TEED on both sides.Related factors were analyzed by Multiple Linear regression.Results The average improvement rate of UPDRSⅢscore after operation was(54.40±16.51)%,and the equivalent dose of levodopa was(37.71±27.48)%lower than that before operation.Within 1 year after STN⁃DBS,the voltage,TEED and left cerebral pulse width of the left and right sides gradually increased with time,and the differences were statistically significant(all P<0.05).There were significant differences in left brain voltage,left brain TEED,right brain voltage,right brain pulse width,right brain TEED and frequency among different clinical subtypes(all P<0.05).There were significant differences in left brain voltage,left brain pulse width,left brain impedance,right brain voltage and right brain TEED among patients with different H⁃Y stages in“off”stage(all P<0.05).Left brain TEED was negatively correlated with age(t=-3.204,95%CI:-1.644--0.364,P=0.003)and positively correlated with DBS postoperative time(t=2.716,95%CI:0.400-2.825,P=0.011).The right brain TEED was negatively correlated with the improvement rate of levodopa impact test(t=-2.114,95%CI:-0.504--0.009,P=0.043),and positively correlated with the time after DBS(t=2.260,95%CI:0.124-2.446,P=0.031).Conclusions The bilateral voltage and TEED gradually increased with time after 1 year of STN⁃DBS in PD patients,while the changes of frequency,pulse width and impedance are small.There are significant differences in TEED and voltage among patients with different clinical subtypes and different H⁃Y stages in“off”stage.Bilateral TEED after STN⁃DBS is related to age,preoperative improvement rate of levodopa impact test and postoperative time of DBS.