中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2021, Vol. 16 ›› Issue (5): 905-909.doi: 10.4103/1673-5374.297089

• 原著:退行性病与再生 • 上一篇    下一篇

双侧丘脑底核脑深部电刺激对帕金森病运动症状的影响：回顾性队列研究

  

  • 出版日期:2021-05-15 发布日期:2020-12-29
  • 基金资助:

    国家自然科学基金项目（31900718，31872773）；国家重点研究发展计划（2017YFA0104704）；江苏省教育厅基础研究计划（19KJB180024，18KJB180020；中国博士后科学基金（2019M651925）；江苏省学生创新创业平台培训计划（201810304031Z）；江苏省六个人才高峰项目（WSN-007）

Effects of bilateral subthalamic nucleus deep brain stimulation on motor symptoms in Parkinson’s disease: a retrospective cohort study

Guo-Xiong Cheng1, #, Shu-Bin Yin2, #, Ying-Hao Yang1, Yuan-Hu Hu2, Chih-Yang Huang3, 4, 5, 6, Qian-Ming Yao1, 2, *, Wei-Jen Ting2, *#br#   

  1. 1 Deparment of Neurosurgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China;  2 Deparment of Neurosurgery, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong Province, China;  3 Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan, China;  4 Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan, China;  5 College of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan, China;  6 Medical Research Center for Exosome and Mitochondria Related Diseases, China Medical University and Hospital, Taichung, Taiwan, China
  • Online:2021-05-15 Published:2020-12-29
  • Contact: Qian-Ming Yao, PhD, yaoqianming@gzhmu.edu.cn; Wei-Jen Ting, PhD, tingweijen@gzhmu.edu.cn.
  • Supported by:
    This study was supported in part by the Guangdong Medical Science Foundation of China, Nos. A2013252 (to GXC), C2013024 (to QMY), and Guangdong Science and Technology Foundation of China, No. 20120318018 (to QMY). 

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摘要：

针对丘脑底核的脑深部电刺激是药物治疗无效的帕金森病患者的选择之一。此次回顾性队列研究27例在广州医科大学附属第一医院对接受过双侧丘脑底核的脑深部电刺激的晚期帕金森病患者的运动功能进行分析，以评估双侧丘脑底核的脑深部电刺的治疗效果。在广州医科大学第六附属医院清远市人民医院分析患者10年的随访数据，数据以接受左旋多巴治疗（用药状态）和未接受左旋多巴治疗（非用药状态）的进行了区分。结果显示，与基线相比，处于非药物治疗状态的帕金森病患者双侧脑深部电刺激后，运动功能改善效果良好。甚至在2年后，非用药状态下的帕金森病患者的运动症状也有改善。与治疗前相比，用药状态患者在5年内表现出更好的治疗效果。但5年后患者的运动障碍、语言、姿势稳定性、步态和认知功能仍会出现恶化。结果说明接受脑深部电刺激治疗的晚期帕金森病患者，5年内的运动功能有明显改善，同时接受左旋多巴胺药物治疗的效果更佳。试验于2018年1月11日经广州医科大学第六附属医院清远市人民医院伦理委员会批准，批准号QPH-IRB-A0140。

https://orcid.org/0000-0001-5712-3448 (Wei-Jen Ting)

关键词: 帕金森病, 电刺激, 丘脑, 多巴胺, 运动障碍, 远期随访, 神经功能, 临床试验

Abstract: Deep brain stimulation of the bilateral subthalamic nucleus (STN) is a therapeutic option for patients with Parkinson’s disease (PD) in whom medical therapies have been ineffective. This retrospective cohort study analyzed the motor function of 27 patients with advanced PD, from the First Affiliated Hospital of Guangzhou Medical University, China, who received deep brain stimulation of the bilateral subthalamic nucleus and evaluated its therapeutic effects. The 10-year follow-up data of patients was analyzed in Qingyuan People’s Hospital, Sixth Affiliated Hospital of Guangzhou Medical University, China. The follow-up data were divided into two categories based on patients during levodopa treatment (on-medication) and without levodopa treatment (off-medication). Compared with baseline, the motor function of on-medication PD patients improved after deep brain stimulation of the bilateral subthalamic nucleus. Even 2 years later, the motor function of off-medication PD patients had improved. On-medication PD patients exhibited better therapeutic effects over the 5 years than off-medication PD patients. On-medication patients’ akinesia, speech, postural stability, gait, and cognitive function worsened only after 5 years. These results suggest that the motor function of patients with advanced PD benefitted from treatment with deep brain stimulation of the bilateral subthalamic nucleus over a period up to 5 years. The overall therapeutic effects were more pronounced when levodopa treatment was combined with deep brain stimulation of the bilateral subthalamic nucleus. This study was approved by Institutional Review Board of Qingyuan People’s Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, China (approval No. QPH-IRB-A0140) on January 11, 2018.

Key words: clinical trial, deep brain stimulation, dopamine, dyskinesia, levodopa, long-term follow-up, neurological function, Parkinson’s disease, thalamus, UPDRS