双侧丘脑底核电刺激对帕金森病患者生活质量影响的研究

目的对给予丘脑底核(STN)电刺激治疗的帕金森病(PD)患者进行生活质量评估,以评价治疗的有效性及不同因素对生活质量的影响。方法41例接受双侧STN深部电刺激(DBS)治疗的PD患者分别于术前及术后12个月应用统一帕金森病评定量表(UPDRS)、Hoehn和Yahr分期、Schwab和England日常生活活动量表、医院焦虑和抑郁量表(HADS)评价其临床情况;帕金森病生活质量问卷(PDQ-39)评价生活质量,并对统计结果进行配对t检验和Spearman相关性检验。结果UPDRS评分中日常生活活动、运动检查、并发症均有明显改善(P<0.001),而精神、行为和情绪无明显改善。HADS量表结果显示患者的焦虑及抑郁评分均有明显改善(P<0.001)。PDQ-39评分中运动、日常生活活动、情绪状态、身体不适、总评分等项均有明显改善(P<0.001),羞耻感也有改善(P<0.05)。相关性检验的结果提示与PDQ-39总评分变化程度成相关性的因素依次为:UPDRS运动检查“关”期(P<0.001), Schwab和England日常生活活动量表“关”期(P<0.001),UPDRS日常生活活动“关”期(P<0.01),HADS-抑郁(P< 0.05)。结论脑深部电刺激能明显改善PD患者的生活质量。

The impact of bilateral deep brain stimulation of the subthalamic nuclei on the health-related quality of life in patients with advanced Parkinson's disease

Objective To examine the impact of the subthalamic nuclei (STN) deep brain stimulation (DBS) on the health-related quality of life (QoL) of patients with advanced Parkinson's disease (PD). Methods Forty-one consecutive patients with refractory motor fluctuations and dyskinesia were assessed with Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn & Yahr stage, Schwab and England Scale, Hospital Anxiety and Depression Scale (HAD), Parkinson's Disease Questionnaire Chinese version (PDQ-39) a week before surgery and 12 months after the surgical procedure. Results Significant benefit was obtained in the activity of daily life (UPDRS section2, P<0.001 off], P < 0.05 on]), motor manifestations (UPDRS section3, P<0.001 on/off]) and complication of disease (UPDRS section4, P < 0.001 on/off]) and no significant in the functional state and mood ( UPDRS section1, P > 0.05on/off]). Some QoL dimensions (mobility, activity of daily living, emotional well being, bodily discomfort) and PDQ-39 Summary Index (PDQ-39SI) showed a significant improvement (P < 0.001). There was correlation between the change obtained in the QoL (PDQ-39SI) and UPDRS secton3 (off medication), Schwab & England (off medication), UPDRS section2 (off medication), HADS-Depression. Conclusions In the accordance with our results, STN-DBS significantly improved important aspects of QoL in patients with advanced PD.