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目的:探讨帕金森(PD)患者丘脑底核深部脑电刺激术(STN-DBS)后神经心理功能的变化特征。方法:共纳入2014年12月到2016年3月武汉大学中南医院诊断的42例PD患者,分为手术组(接受STN-DBS,同时服用抗PD药物)和对照组(仅服用抗PD药物)。在基线期和6月随访期,服用抗PD药物和电刺激的状态下,收集一般人口学信息,并用统一帕金森评分量表、艾森布鲁克认知检测-修订版、Hoehn-Yahr分期、Schwab-England日常生活能力、汉密尔顿焦虑和抑郁量表对患者的精神、日常生活能力、运动症状、药物并发症、定向力和注意力、记忆、语言流畅性、语言、视空间、疾病分期、焦虑和抑郁进行评测。用配对t检验或Wilcoxon符号秩和检验比较基线和随访期资料,用独立样本t检验或Mann-Whitney U检验比较手术组和对照组资料。结果:手术组PD患者术后总体认知功能未见明显变化,语言流畅性显著下降(P=0.022)。与对照组相比,手术组PD患者运动能力(P=0.000)、日常生活能力(P=0.047)、抑郁(P=0.009)和焦虑(P=0.003)症状显著改善,服用抗帕金森药物减少(P=0.000)。结论:STN-DBS对PD患者认知功能总体安全,可改善患者日常生活能力、抑郁、焦虑和运动等症状。本前瞻性研究可为中晚期PD患者接受STN-DBS治疗提供一定的指导意义。
Objective: To investigate the changes of neuropsychological function after deep brain stimulation (STN-DBS) in the subthalamic nucleus of Parkinson’s disease (PD). METHODS: A total of 42 patients with PD diagnosed at Zhongnan Hospital of Wuhan University from December 2014 to March 2016 were divided into operation group (receive STN-DBS and anti-PD drug) and control group (anti-PD drug only) . General demographic information was collected at baseline and in the June follow-up, with anti-PD drugs and electrical stimulation, and was assessed using the Unified Parkinson’s Rating Scale, the Eisenbrook Cognitive Testing-Revised, Hoehn-Yahr Staging, Schwab -England daily living ability, Hamilton Anxiety and Depression Scale for the patient’s spirit, daily living ability, motor symptoms, drug complications, orientation and attention, memory, fluency, language, visual space, disease staging, anxiety and Depression for evaluation. Baseline and follow-up data were compared using the paired t-test or the Wilcoxon signed rank sum test, and data from the surgical and control groups were compared using the independent sample t-test or the Mann-Whitney U test. Results: There was no significant change in overall cognitive function after operation in PD patients, and the fluency of language was significantly decreased (P = 0.022). Compared with the control group, the patients with PD in operation group had significantly improved motor performance (P = 0.000), daily living ability (P = 0.047), depression (P = 0.009) and anxiety (P = 0.003) (P = 0.000). CONCLUSIONS: STN-DBS is generally safe for patients with PD and can improve symptoms such as daily living, depression, anxiety and motor. This prospective study may provide some guidance for the treatment of advanced PD patients with STN-DBS.