帕金森病外科治疗的综合评价与相关基础研究

目的通过综合研究对帕金森病(PD)外科治疗的价值和疗效进行全面评价。方法采用医学心理学测验(WAISRC)、临床记忆量表(MMPI)、神经生理学检测(听觉P300地形图)、神经电生理学(体感诱发电位SEP)和神经生化检查的脑脊液中多巴胺(DA)、5羟色胺(5HT)、去甲肾上腺素(NE)及其代谢产物)等对手术前后患者进行综合研究,并设对照组。结果手术前后智能和精神症状无显著性差异(P>0.05);手术后SEP的N20波峰潜伏期较术前缩短,统计学处理有差异(P左<0.005,P右<0.05),手术侧较非手术侧峰潜伏期缩短(P<0.05)。伴发抑郁患者组CSF中单胺类神经递质5HT的代谢产物5羟吲哚乙酸(5HIAA)和NE的代谢产物3甲氧基4羟基苯乙二醇(MHPG)低于对照组(P<0.01),患者组DA、高香草酸(HVA),5HT,5HIAA、NE、MPHG低于正常对照组(P<0.001),手术组上述各项均高于手术前组(P<0.001);结论手术不会加重智能和精神障碍;听觉P300地形图可作为诊断和疗效判定的客观指标之一;帕金森病及伴发抑郁症状均具有相应生化病理学基础。

Basic research and comprehensive evaluation of surgical treatment on Parkinson's disease

Objective Comprehensively evaluate the value and effect of surgical management for Parkinson's disease(PD) through multitudinous analysis.Methods Pre- and postoperative results were analyzed through trial controlled study of neuropsychological Weschler adult intelligence scale(WAIS-RC),clinical memory rating scale,Mommesota multiphasic personality inventory(MMPI)assessments,neurophysiological examina-tions(P300 from auditory stimuli),somato-sensory evoked potential (SEP),brainstem auditory evoked potential(BAEP) and neurochemistry examinations of cerebral spinal fluid(CSF) levels of dopamine(DA), 5-hydroxytryptamine(5-HT),nor pinephrine(NE) and their metabolites.Rusults Intelligence and mental disorders acquired no significant changes( P<0.5) after surgery.Latent period of N20 peak of SEP shortened significantly after operation( P<0.005, P<0.05).CSF levels of 5-hydroxyindoleacetic acid (5-HIAA) and 3-methoy-4-hydroxy-phenylglycol (MHPG) in PD patients with depression were significantly lower than that in contral group( P<0.01).CSF levels of DA,homovanilic acid (HVA),5-HT,5-HIAA,NE,MPHG are lower in patients than that in controlled group ( P<0.001),and elevated after surgery.Conclusions Surgical management will not aggravate intellectual and mental disorders;P300 is objective criteria of therapy evalution;the occurrence of depression in PD patients has its biochemical and pathological basis.