尾状核指数对帕金森病脑深部电刺激术疗效的影响

目的 探讨尾状核指数对帕金森病（PD）双侧苍白球内侧部（GPi）脑深部电刺激术（DBS）疗效的影响。方法 回顾性分析2018年8月至2020年12月双侧GPi-DBS治疗的36例PD的临床资料。术前应用MRI测量尾状核指数、Evans指数及第三脑室宽度。术前、术后6个月应用39项帕金森病问卷（PDQ-39）评分、统一帕金森病评定量表Ⅲ（UPDRS-Ⅲ）评分、左旋多巴等效日剂量（LEDD）评估疗效。根据术后6个月UPDRS-Ⅲ评分分为改善组（n=26）与恶化组（n=10）。结果 术后6个月，PDQ-39评分、UPDRS-Ⅲ评分、LEDD均明显降低（P<0.05）。恶化组尾状核指数、第三脑室宽度较改善组明显增大（P<0.05），而Evans指数无明显变化（P>0.05）。多因素logistic回归分析显示尾状核指数≥0.16(OR=1.76;95%CI 1.09～3.18;P=0.017)是PD术后UPDRS-Ⅲ评分恶化的独立影响因素。结论 双侧GPi-DBs明显改善PD症状，尾状核指数可用于评估PD病人双侧GPi-DBS后运动功能。

Effect of bicaudate index on outcomes of deep brain stimulation for patients with Parkinson's disease

Objective To investigate the effect of bicaudate index on the outcomes of deep brain stimulation (DBS) for patients with Parkinson's disease (PD). Methods The clinical data of 36 patients with PD who underwent bilateral globus pallidus interna (GPi) DBS between August 2018 and December 2020 were analyzed retrospectively. The bicaudate index, the Evans index and the width of the third ventricle were measured using MRI before operation. The efficacy was evaluated using the 39-item Parkinson's Disease Questionnaire (PDQ-39) score, Unified Parkinson's Disease Rating Scale Ⅲ (UPDRS-Ⅲ) score and levodopa equivalent daily dose (LEDD) before and 6 months after surgery. According to the UPDRS-Ⅲ score at 6 months after operation, the patients were divided into improvement group (n=26) and deterioration group (n=10). Results At 6 months after operation, PDQ-39 score and UPDRS-Ⅲ score were significantly improved (P<0.05), and LEDD was significantly decreased (P<0.05). The bicaudate index and the width of the third ventricle in the deterioration group were significantly higher than those in the improved group (P<0.05), while the Evans index did not significantly change (P>0.05). Multivariate logistic regression analysis showed that bicaudate index ≥0.16 was an independent risk factor of UPDRS-Ⅲ score deterioration after DBS (OR=1.76; 95% CI 1.09~3.18; P=0.017). Conclusions Bilateral GPi-DBS significantly improves PD symptoms. Bicaudate nucleus index can be used to evaluate motor function after bilateral GPI-DBS in PD patients.