双侧丘脑底核脑深部电刺激对帕金森病患者情绪和认知功能影响的单中心5年随访研究

A single-center 5-year follow-up study on the effects of bilateral deep brain stimulation on mood and cognition in patients with Parkinson's disease

目的探讨双侧丘脑底核脑深部电刺激(STN-DBS)对帕金森病(PD)患者情绪和认知功能的影响。方法回顾性分析2014年4月至2016年12月于南京医科大学附属脑科医院功能神经外科行双侧STN-DBS治疗的80例PD患者术后5年的临床资料。术前及术后6个月,1、2、3、4、5年时分别采用药物关期状态下的统一PD评定量表第三部分(UPDRS-Ⅲ)、39项PD生活质量问卷(PDQ-39)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、简易精神状态量表(MMSE)及蒙特利尔认知评估量表(MoCA)进行评估,并计算左旋多巴每日等效剂量(LEDD)。比较患者手术前、后各项评分和LEDD的变化,并且分析运动症状(UPDRS-Ⅲ评分)、生活质量(PDQ-39评分)的改善情况与MMSE、MoCA、HAMA、HAMD评分改善率之间的相关性。结果与术前相比,患者术后6个月,1、2、3、4、5年时的UPDRS-Ⅲ评分(药物关期状态)、LEDD、PDQ-39评分、HAMA评分、HAMD评分均明显降低,MoCA评分均较术前升高,差异均有统计学意义(均P<0.05)。术后6个月,1、2、3、4年的MMSE评分较术前升高,差异均有统计学意义(均P<0.05),而术后5年的MMSE评分与术前的差异无统计学意义(P>0.05)。Spearman等级相关分析结果显示,患者在术后1、3、5年的MMSE评分改善率与对应时间点的PDQ-39评分改善率呈正相关关系(术后1年:r_(s)=0.26,P=0.026;术后3年:r_(s)=0.23,P=0.043;术后5年:r_(s)=0.35,P=0.002);术后5年的MoCA评分改善率与对应时间点的PDQ-39评分改善率呈正相关关系(r_(s)=0.28,P=0.014)。患者术后1、3、5年的MMSE、MoCA、HAMA、HAMD评分改善率与对应时间点的UPDRS-Ⅲ评分改善率均无明显相关性(均P>0.05)。结论双侧STN-DBS对PD患者焦虑、抑郁情绪及总体认知功能的改善长期有效,且PD患者总体认知功能的改善与生活质量的改善有关。

Objective To explore the effect of deep brain stimulation of bilateral subthalamic nucleus(STN-DBS)on the mood and cognition in patients with Parkinson's disease(PD).Methods The clinical data of 80 PD patients who underwent bilateral STN-DBS treatment at the Functional Neurosurgery of Affiliated Brain Hospital of Nanjing Medical University from April 2014 to December 2016 were retrospectively analyzed 5 years after surgery.Before surgery,6 months after surgery,and 1,2,3,4,and 5 years later,the patients were assessed based on the Unified Parkinson's Disease Rating Scale Part Ⅲ(UPDRS-Ⅲ),the 39-item PD Quality of Life Questionnaire in the off state(PDQ-39),Hamilton Anxiety Rating Scale(HAMA),Hamilton Depression Rating Scale(HAMD),Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA);the L-dopa equivalent daily dose(LED)was calculated.We compared the changes in scores of patients and the LEDD before and after surgery,and analyze the correlation between the improvement of motor symptoms(UPDRS-Ⅲ score),quality of life(PDQ-39 score)and the improvement rate of MMSE,MoCA,HAMA,and HAMD scores.Results Compared with those before surgery,the patient's UPDRS-Ⅲ score(off period),LEDD,PDQ-39 score,HAMA score,and HAMD score at 6 months,1,2,3,4,and 5 years after surgery were all significantly reduced,the MoCA scores were all higher than those before surgery,and the differences were statistically significant(all P<0.05).The MMSE scores at 6 months,1,2,3,and 4 years after surgery were higher than those before surgery,and the differences were statistically significant(all P<0.05),while the MMSE scores at 5 years after surgery were not different from those before surgery(P>0.05).Spearman rank correlation analysis results showed that there was a positive correlation between the patient's MMSE score improvement rate at 1,3,and 5 years after surgery and the PDQ-39 score improvement rate at the same time points(1 year after surgery:r_(s)=0.26,P=0.026;3 years after surgery:r_(s)=0.23,P=0.043;5 years after surgery:r_(s)=0.35,P=0.002).There was a positive correlation(r_(s)=0.28,P=0.014)between the MoCA score improvement rate 5 years after surgery and the PDQ-39 score improvement rate corresponding to the same time point.There was no significant correlation between the patient's MMSE,MoCA,HAMA,and HAMD score improvement rates at 1,3,and 5 years after surgery and the UPDRS-Ⅲ score improvement rate at the corresponding time points(all P>0.05).Conclusions Bilateral STN-DBS is long-term effective in improving anxiety,depression and overall cognitive function in PD patients.The improvement in overall cognitive function in PD patients is related to the improvement in quality of life.