摘要： 目的 探讨脑深部电刺激术对帕金森病非运动症状的治疗效果。方法 纳入2015年1月至2021年1月在天津市环湖医院行脑深部电刺激术的41例帕金森病患者,于术前和术后3、6和12个月采用简易智能状态检查量表(MMSE)和蒙特利尔认知评价量表(MoCA)评估认知功能,Beck抑郁量表第二版(BDI-Ⅱ)和汉密尔顿焦虑量表(HAMA)评估抑郁和焦虑,匹兹堡睡眠质量指数(PSQI)和Epworth嗜睡量表(ESS)评估睡眠障碍和嗜睡,统一帕金森病评价量表第三部分(UPDRSⅢ)评估运动症状,左旋多巴日等效剂量(LEDD)评估术后对抗帕金森病药物的依赖程度。结果 帕金森病患者手术前后BDI-Ⅱ评分(P=0.000),HAMA总评分(P=0.000)及其躯体性焦虑(P=0.000)、精神性焦虑(P=0.000)分评分,PSQI总评分(P=0.000)及其主观睡眠质量(P=0.000)、入睡时间(P=0.000)、睡眠时间(P=0.000)、睡眠效率(P=0.000)、睡眠障碍(P=0.000)、睡眠药物应用(P=0.015)和日间功能障碍(P=0.000)分评分,ESS评分(P=0.000),UPDRSⅢ评分(P=0.000)及LEDD (P=0.000)差异均有统计学意义;与术前相比,术后3、6和12个月时BDI-Ⅱ评分、HAMA总评分、PSQI总评分和ESS评分改善率分别为46.00%、33.58%、34.67%和34.30%,49.69%、35.01%、38.19%和36.20%,50.51%、35.24%、39.77%和39.44%,术后不同观察时间点各项评分及其分评分均较术前差异有统计学意义(均P < 0.01)。而手术前后MMSE总评分及其定向力、记忆力、注意力和计算力、回忆能力、语言功能分评分,以及MoCA总评分及其视空间与执行功能、命名、注意、语言、抽象、延迟回忆、定向分评分则差异无统计学意义(均P > 0.05)。结论 脑深部电刺激术可以显著改善帕金森病运动症状以及情绪和睡眠障碍两项非运动症状,减少抗帕金森病药物剂量,但对认知功能无明显改善作用。

关键词: 帕金森病, 深部脑刺激法, 认知障碍, 焦虑, 抑郁, 睡眠异常

Abstract: Objective To investigate the therapeutic effect of deep brain stimulation (DBS) on non- motor symptoms of Parkinson's disease (PD). Methods A total of 41 patients with PD who underwent DBS in Tianjin Huanhu Hospital from January 2015 to January 2021 were selected as subjects. The cognitive function was assessed by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at 3, 6 and 12 months after operation. Beck Depression Inventory Ⅱ (BDI-Ⅱ) and Hamilton Anxiety Rating Scale (HAMA) assessed depression and anxiety, Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) assessed sleep disorders and sleepiness, and Unified Parkinson's Disease Rating Scale Ⅲ (UPDRSⅢ) assessed motor symptoms. Levodopa equivalent daily dose (LEDD) was used to assess postoperative dependence on anti-PD drugs. Results The BDI- Ⅱ score (P=0.000), HAMA total scores (P=0.000) and its somatic anxiety (P=0.000), mental anxiety (P=0.000), PSQI total scores (P=0.000) and its subjective sleep quality (P=0.000), time to fall asleep (P=0.000), sleep duration (P=0.000), sleep efficiency (P=0.000), sleep disorders (P=0.000), sleep drug use (P=0.015),daytime dysfunction (P=0.000), ESS score (P=0.000), UPDRSⅢ score (P=0.000) and LEDD (P=0.000) had statistically significant differences before and after surgery. The improvement rates of BDI-Ⅱ, HAMA, PSQI and ESS were 46.00%, 33.58%, 34.67% and 34.30%, 49.69%, 35.01%, 38.19% and 36.20%, 50.51%, 35.24%, 39.77% and 39.44% at 3, 6 and 12 months after surgery respectively. The scores at different postoperative observation points were significantly different from those before surgery (P < 0.01, for all). However, there were no significant differences in MMSE total scores and its score of orientation, memory, attention and computation, recall ability and language function, as well as MoCA total scores and its score of visual spatial and executive function, naming, attention, language, abstraction, delayed recall and orientation before and after surgery (P > 0.05, for all). Conclusions DBS can significantly improve the motor symptoms, mood and sleep disorder of non - motor symptoms (NMS) in PD patients, and reduce the dose of anti-PD drugs, but has no effect on cognitive function.

Key words: Parkinson disease, Deep brain stimulation, Cognition disorders, Anxiety, Depression, Dyssomnias