脑深部电刺激手术治疗帕金森型多系统萎缩临床疗效的研究
Clinical Efficacy of Deep Brain Stimulation Surgery for Parkinson’s Multi-System Atrophy
DOI: 10.12677/ACM.2023.1381839, PDF,   
作者: 杨海燕:右江民族医学院研究生院,广西 百色;李忠华*, 黄礼德:百色市人民医院神经外科,广西 百色
关键词: 帕金森型多系统萎缩脑深部电刺激临床疗效非运动症状Parkinsonian Multiple System Atrophy Deep Brain Stimulation Clinical Effect Non-Motor Symptom
摘要: 目的:拟探讨脑深部电刺激手术治疗帕金森型多系统萎缩的临床疗效。方法:选取百色市人民医院2021年1月至2022年3月收治的29例帕金森型多系统萎缩患者,按照随机分组的方法分为手术组(9例)和对照组(20例),手术组采用丘脑底核脑深部电刺激手术治疗,对照组采用药物保守治疗,比较2组术后1个月、3个月、6个月和1年的① 统一帕金森病评定量表(UPDRS)、② 日常生活能力量表(ADL)、③ 非运动症状筛查量表(NMSS)、④ 汉密尔顿抑郁量表(HAMD)、⑤ 汉密尔顿焦虑量表(MHMD)、⑥ 改良淡漠评定量表(MMSE)的评分。结果:两组患者术前的一般资料差异无统计学意义(P > 0.05),而手术组术后1个月、3个月、6个月、1年的改良淡漠评定量表较对照组变化不大(P > 0.05),差异无统计学意义。ADL评分明显高于对照组(P < 0.05),其他各项评分均明显低于对照组(P < 0.05),差异有统计学意义。结论:脑深部电刺激手术治疗帕金森型多系统萎缩有一定的临床疗效,患者术后运动、非运动症状评分及精神行为认知均明显提高,因此是安全、有效的治疗方法,值得推广。
Abstract: Objective: To investigate the clinical effect of deep brain stimulation in the treatment of Parkinson’s multi-system atrophy. Methods: Twenty-nine patients with Parkinson’s multiple system atrophy admitted to Baise People’s Hospital from January 2021 to March 2022 were selected and divided into an operation group (9 cases) and a control group (20 cases) according to random grouping. The operation group was treated with deep brain stimulation of subthalamus nucleus, while the control group was treated with conservative drug therapy. The results of ① Unified Parkinson’s Disease Rating Scale (UPDRS), ② Ability of Daily Living (ADL), ③ non-motor Symptom Screening Scale (NMSS), ④ Hamilton Depression Scale (HAMD), ⑤ Hamilton Anxiety Scale (MHMD), and ⑥ Modified Inactivity Rating Scale (MMSE) were compared 1 month, 3 months, 6 months and 1 year after sur-gery. Results: There was no significant difference in the general data of the two groups before sur-gery (P > 0.05), while the modified indifference rating scale of the operation group at 1 month, 3 months, 6 months and 1 year after surgery had no significant difference compared with the control group (P > 0.05). ADL score was significantly higher than control group (P < 0.05), and other scores were significantly lower than control group (P < 0.05), the difference was statistically significant. Conclusion: Deep brain stimulation has a certain clinical effect in the treatment of Parkinson’s mul-ti-system atrophy, and the scores of motor and non-motor symptoms and mental behavior cognition of patients after surgery are significantly improved. Therefore, it is a safe and effective treatment method, worthy of promotion.
文章引用:杨海燕, 李忠华, 黄礼德. 脑深部电刺激手术治疗帕金森型多系统萎缩临床疗效的研究[J]. 临床医学进展, 2023, 13(8): 13162-13170. https://doi.org/10.12677/ACM.2023.1381839

参考文献

[1] Chelban, V., Catereniuc, D., Aftene, D., et al. (2020) An Update on MSA: Premotor and Non-Motor Features Open a Window of Opportunities for Early Diagnosis and Intervention. Journal of Neurology, 267, 2754-2770. [Google Scholar] [CrossRef] [PubMed]
[2] Niu, X., Cheng, Y., Hu, W., et al. (2022) Application of Bulbocavernosus Reflex Combined with Anal Sphincter Electromyography in the Diagnosis of MSA and PD. Interna-tional Journal of Neuroscience, 132, 851-856. [Google Scholar] [CrossRef] [PubMed]
[3] 梁奇明, 连立飞, 许峰, 等. 药源性帕金森综合征的临床分型及特征[J]. 卒中与神经疾病, 2022, 29(5): 405-409.
[4] 王雪梅, 曹振汤, 刘亘梁, 等. 交感皮肤反应联合肛门括约肌肌电图对多系统萎缩与帕金森病的诊断价值[J]. 中华老年心脑血管病杂志, 2021, 23(1): 47-50.
[5] 毛媛, 沈聪, 刘丰韬, 等. 多系统萎缩患者认知损害的临床特点及其影响因素[J]. 中国临床神经科学, 2022, 30(2): 174-182.
[6] Zhang, L., Cao, B., Ou, R., et al. (2017) Non-Motor Symptoms and the Quality of Life in Multiple Sys-tem Atrophy with Different Subtypes. Parkinsonism & Related Disorders, 35, 63-68. [Google Scholar] [CrossRef] [PubMed]
[7] 张灵语, 商慧芳. 多系统萎缩的诊治进展[J]. 罕见病研究, 2022, 1(2): 206-216.
[8] 国家卫生健康委医政医管局, 中国罕见病联盟, 北京协和医院. 2019年罕见病诊疗指南[S]. 2019.
[9] 王毅. 血管性帕金森综合征中西医结合诊治专家共识2022 [J]. 中国卒中杂志, 2022, 17(4): 334-340.
[10] 李淑华, 陈海波. 帕金森病的诊断与鉴别诊断[J]. 中国临床医生杂志, 2021, 49(6): 642-645.
[11] Wenning, G.K., Stankovic, I., Vignatelli, L., et al. (2022) The Movement Disor-der Society Criteria for the Diagnosis of Multiple System Atrophy. Movement Disorders, 37, 1131-1148. [Google Scholar] [CrossRef] [PubMed]
[12] Pérez-Soriano, A., Giraldo, D.M., Ríos, J., et al. (2021) Progression of Motor and Non-Motor Symptoms in Multiple System Atrophy: A Prospective Study from the Catalan-MSA Registry. Journal of Parkinson’s Disease, 11, 685-694. [Google Scholar] [CrossRef
[13] Artusi, C.A., Dwivedi, A.K., Romagnolo, A., et al. (2019) Association of Subthalamic Deep Brain Stimulation with Motor, Functional, and Pharmacologic Outcomes in Patients with Mono-genic Parkinson Disease: A Systematic Review and Meta-Analysis. JAMA Network Open, 2, e187800. [Google Scholar] [CrossRef] [PubMed]
[14] 石松鑫, 王大力, 李弘, 等. 血管性帕金森综合征与帕金森病认知功能的比较[J]. 中国卒中杂志, 2022, 17(4): 341-345.
[15] Kauppila, L.A., Ten Holter, S., van de Warrenburg, B., et al. (2022) A Guide for the Differential Diagnosis of Multiple System Atrophy in Clinical Practice. Journal of Parkinson’s Disease, 12, 2015-2027. [Google Scholar] [CrossRef
[16] Brozova, H., Barnaure, I., Ruzicka, E., et al. (2021) Short- and Long-Term Effects of DBS on Gait in Parkinson’s Disease. Frontiers in Neurology, 12, Article ID: 688760. [Google Scholar] [CrossRef] [PubMed]
[17] Meyer, M., Lamare, F., Asselineau, J., et al. (2021) Brain 5‐HT1A Receptor Binding in Multiple System Atrophy: An [18F]-MPPF PET Study. Movement Disorders, 36, 246-251. [Google Scholar] [CrossRef] [PubMed]
[18] Rascol, O., Cochen De Cock, V., Pavy Le Traon, A., et al. (2021) Fluoxe-tine for the Symptomatic Treatment of Multiple System Atrophy: The MSA-FLUO Trial. Movement Disorders, 36, 1704-1711. [Google Scholar] [CrossRef] [PubMed]
[19] Campese, N., Leys, F., Wenning, G.K., et al. (2022) Bedside Assessment of Autonomic Dysfunction in Multiple System Atrophy. Journal of Parkinson’s Disease, 12, 2277-2281. [Google Scholar] [CrossRef
[20] Brumberg, J., Kuzkina, A., Lapa, C., et al. (2021) Dermal and Cardiac Autonomic Fiber Involvement in Parkinson’s Disease and Multiple System Atrophy. Neurobiology of Disease, 153, Ar-ticle ID: 105332. [Google Scholar] [CrossRef] [PubMed]
[21] Fifel, K. and De Boer, T. (2021) The Circadian System in Parkin-son’s Disease, Multiple System Atrophy, and Progressive Supranuclear Palsy. In: Handbook of Clinical Neurology, Vol. 179, Elsevier, Amsterdam, 301-313. [Google Scholar] [CrossRef
[22] Dorszewska, J., Kowalska, M., Prendecki, M., et al. (2021) Oxidative Stress Factors in Parkinson’s Disease. Neural Regeneration Research, 16, 1383-1391. [Google Scholar] [CrossRef] [PubMed]
[23] Sidoroff, V., Raccagni, C., Kaindlstorfer, C., et al. (2021) Charac-terization of Gait Variability in Multiple System Atrophy and Parkinson’s Disease. Journal of Neurology, 268, 1770-1779. [Google Scholar] [CrossRef] [PubMed]
[24] Ligaard, J., Sannæs, J. and Pihlstrøm, L. (2019) Deep Brain Stimulation and Genetic Variability in Parkinson’s Disease: A Review of the Literature. NPJ Parkinson’s Disease, 5, Article No. 18. [Google Scholar] [CrossRef] [PubMed]
[25] Badihian, N., Jackson, L.M., Klassen, B.T., et al. (2022) The Effects of Deep Brain Stimulation in Patients with Multiple System Atrophy. Journal of Parkin-son’s Disease, 12, 2595-2600. [Google Scholar] [CrossRef
[26] 顾梦阅, 翟金国. 深部脑刺激术治疗抑郁障碍研究进展[J]. 济宁医学院学报, 2021, 44(5): 352-355.
[27] 王燕, 刘嘉霖, 张鹏, 等. 脑深部电刺激术治疗帕金森病作用机制的研究现状[J]. 中西医结合心脑血管病杂志, 2021, 19(4): 604-606.