丘脑底核与苍白球内侧部电刺激术治疗帕金森病疗效的Meta分析

目的 系统评价脑深部电刺激术（DBS）作用丘脑底核（STN）与苍白球内侧部（GPi）治疗帕金森病（PD）的疗效。方法 计算机检索2015年6月之前在PubMed、Cochrane Library、Embase、CNKI及VIP等数据库中DBS作用STN或GPi治疗PD的随机临床对照研究，按纳入排除标准进行资料的筛选和提取，利用RevMan 5.3软件进行Meta分析。结果 纳入7个研究共613例患者，其中STN组331例，GPi组282例。Meta分析显示，STN-DBS与GPi-DBS治疗后，患者运动症状改善效果（SMD=0.36；95% CI为-0.07~0.78；P=0.10）及生活质量改善（SMD=-0.20，95%CI为-0.78~0.39；P=0.51）相似，且术后3年均效果稳定。STN组较GPi组能明显减少术后药物用量（SMD=0.37；95% CI为0.19~0.55；P<0.0001）；gpi组抑郁发生率较stn组明显减少（rr ci为="" 1.28~2.27；p="0.0003）。结论 STN-DBS与GPi-DBS治疗PD后，患者运动症状改善效果与生活质量改善效果相似，STN -DBS能有效减少术后用药量，GPi-DBS术后抑郁发生率更低。

Meta-analysis of curative effects of electric stimulation of the globus pallidus and subthalamic nucleus on Parkinson disease

Objective To compare the curative effect of electric stimulation of subthalamic nucleus (STN) on Parkinson disease (PD) with the electric stimulation of internal globus pallidus (GPi). Methods PubMed, Cochrane Library, Embase, CNKI and Weipu databases were searched for the random-control studies of the comparison of the curative effects on PD between the electric stimulations of STN and GPi. Meta analysis of the outcomes of the searched studies was performed by RevMan 5.3. Results Of 613 patients with PD in the searched seven studies, 331 received the electric stimulation of STN and 282 GPi. Meta analysis showed that there were insignificant difference in the curative effects on the motor symptom (SMD=0.36; 95% CI -0.07 to 0.78; P=0.10) and quality of life (SMD=-0.20; 95% CI -0.78 to 0.39; P=0.51). The levodopa equivalent dose controlling PD after the operation was significantly less in the patients receiving the stimulation of STN than that in the patients receiving the stimulation of GPi, in whom the rate of occurrence of depression was significantly lower than that in the patients receiving the stimulation of STN (RR=1.71; 95% CI 1.28 to 2.27; P=0.0003). Conclusions The effect of the electric stimulation of STN on PD was similar to the electric stimulation of GPi, but the electric stimulation of STN may produce greater decrease in dose of drug controlling PD, whereas the electric stimulation of GPi may produce the significantly lower rate of occurrence of postoperative depression in the patients with PD.