双侧丘脑底核脑深部电刺激对PD患者焦虑症状的短期影响

目的探讨双侧丘脑底核脑深部电刺激(STN-DBS)对帕金森病(PD)患者焦虑症状及生活质量的短期影响。方法对上海交通大学附属瑞金医院功能神经外科中心自2017年8月至2019年8月行双侧STN-DBS治疗的39例PD患者,分别于术前、术后1个月和末次随访时进行贝克焦虑自评量表(BAI)、贝克抑郁自评量表(BDI)评分,于术前和术后末次随访时进行帕金森病患者生活质量问卷-8项(PDQ-8)评分,采用统计学方法分析各节点间评分的差异,以及评分改善程度间的相关性;并进一步依据术前BAI评分将患者分为无焦虑组(n=18)、轻度焦虑组(n=10)、中度焦虑组(n=8)和重度焦虑组(n=3),以进行亚组分析。结果(1)39例患者术后1个月及末次随访时的BAI评分[14(8,20)分、9(3,14)分]均明显低于术前[16(9,27)分],术后末次随访时的BDI评分[8(6,16)分]及PDQ-8评分[3(2,6)分]均明显低于术前[15(8,21)分、9(6,13)分],差异均有统计学意义(P<0.05)。(2)相关性分析显示,术后末次随访时的BAI评分较术前的改善程度与BDI评分的改善程度呈正相关关系(rs=0.722,P=0.000),也与术前BDI评分及术前PDQ-8评分呈负相关关系(rs=-0.714,P=0.000;rs=-0.378,P=0.018)。(3)亚组分析显示,轻度焦虑组和中度焦虑组患者中,术后末次随访时的BAI评分均明显低于术前,差异均有统计学意义(P<0.05);轻度焦虑组、中度焦虑组与重度焦虑组患者的术后末次随访时的BAI评分较术前的改善程度均明显高于无焦虑组,差异均有统计学意义(P<0.05)。结论双侧STN-DBS能在短期内显著改善PD患者的焦虑症状,提高其生活质量,提示STN参与了PD患者焦虑症状的神经机制。

Short-term influence of bilateral deep brain stimulation of subthalamic nucleus in anxiety symptoms in patients with Parkinson's disease

Objective To evaluate the short-term influence of bilateral subthalamic deep brain stimulation(STN-DBS)in anxiety symptoms and quality of life in patients with Parkinson's disease(PD).Methods Thirty-nine PD patients underwent bilateral STN-DBS in our hospital from August 2017 to August 2018 were chosen in our study.Beck Anxiety Inventory(BAI)and Beck Depression Inventory(BDI)scales were performed in these patients before and one month after surgery,and at the last follow-up,respectively.Parkinson's Disease Questionnaire-8(PDQ-8)was performed before surgery and at the last follow-up.Statistical methods were used to analyze the differences of the above scores at different time points,and correlations between each two improvement degrees of above scores.The participants were subsequently divided into four groups based on preoperative BAI scores:no anxiety group(n=18),mild anxiety group(n=10),moderate anxiety group(n=8),and severe anxiety group(n=3);the above scales were performed.Results(1)The BAI scores of 39 patients one month after surgery and at the last follow-up(14[8,20]and 9[3,14])were significantly lower than those before surgery(16[9,27]),and the BDI scores(8[6,16])and PDQ-8 scores(3[2,6])at the last follow-up were significantly lower than those before surgery(15[8,21]and 9[6,13],P<0.05).(2)Correlation analysis revealed that the improvement degree of BAI scores was positively correlated with that of BDI scores(rs=0.722,P=0.000),and negatively correlated with preoperative baseline scores of BDI and PDQ-8,respectively(rs=-0.714,P=0.000;rs=-0.378,P=0.018).(3)The BAI scores in the mild and moderate anxiety groups at the last follow-up were significantly lower as compared with the preoperative baseline BAI scores(P<0.05).The improvement degree of BAI scores in mild,moderate,and severe anxiety groups was significantly higher than that in the no anxiety group(P<0.05).Conclusion The bilateral STN-DBS has considerable benefit effect on anxiety symptoms and health-related quality of life in PD patients during short-term follow-up,suggesting an involvement of STN in the pathogenesis of anxiety in PD.