摘要：

目的 评价丘脑底核脑深部电刺激术联合药物治疗帕金森病的有效性和安全性。方法 以subthalamic nucleus、deep brain stimulation、DBS、STN、Parkinson disease、random 等英文检索词，计算机检索1980 年1 月1 日-2016 年10 月1 日美国国立医学图书馆生物医学信息检索系统、荷兰医学文摘、Cochrane 图书馆等数据库收录的关于丘脑底核脑深部电刺激术联合药物治疗帕金森病的随机对照临床试验，采用Jadad 量表、Cochrane 系统评价手册和RevMan 5.2 统计软件进行文献质量评价和Meta 分析。结果 共获得3245 篇文献，经剔除重复和不符合纳入标准者，最终纳入6 项高质量（Jadad 评分≥ 4 分）临床试验共958 例帕金森病患者。Meta 分析显示：与单纯药物治疗相比，丘脑底核脑深部电刺激术联合药物治疗可以显著降低帕金森病患者服药（SMD =-0.570，95%CI：-0.710 ~ - 0.430；P = 0.000）和未服药（SMD =-1.170，95%CI：-1.500 ~ -0.850；P = 0.000）状态下统一帕金森病评价量表第三部分（UPDRSⅢ）评分，以及UPDRSⅠ评分（SMD =-0.150，95%CI：-0.290 ~ -0.010；P = 0.030）和39 项帕金森病调查表评分（SMD =-0.510，95%CI：-0.660 ~ -0.370；P = 0.000）；但增加严重不良事件（RD = 0.140，95%CI：0.090 ~0.190；P = 0.000）和构音障碍不良事件（RD = 0.070，95%CI：0.010 ~ 0.120；P = 0.020）发生率，而减少运动障碍不良事件发生率（RR = 0.450，95%CI：0.330 ~ 0.620；P = 0.000）。结论 丘脑底核脑深部电刺激术联合药物治疗能够显著改善帕金森病患者运动功能、精神状态和生活质量，但术后发生严重不良事件和构音障碍不良事件的风险增加，应引起临床医师的重视。

关键词: 帕金森病, 丘脑底核, 深部脑刺激法, 药物疗法, Meta分析

Abstract:

Objective To evaluate the efficacy and safety of subthalamic nucleus deep brain stimulation (STN-DBS) combined with drug therapy for treating Parkinson's disease (PD). Methods Retrieve relevant randomized controlled trials (RCTs) from online databases (January 1, 1980-October 1, 2016) as PubMed, EBMASE/SCOPUS and Cochrane Library with key words: subthalamic nucleus, deep brain stimulation, DBS, STN, Parkinson disease, random. Selection of studies was performed according to pre-designed inclusion and exclusion criteria. Quality of studies was evaluated by using Jadad Scale and Cochrane Handbook for Systematic Reviews of Interventions. All data were pooled by RevMan 5.2 software for Meta-analysis. Results The research enrolled 3245 articles, from which 6 studies with Jadad score ≥ 4 were chosen after excluding duplicates and those not meeting the inclusion criteria. A total of 958 PD patients were included. Meta-analysis showed that comparing with best medical treatment (BMT), STN-DBS combined with drug therapy significantly reduced the scores of Unified Parkinson's Disease Rating Scale (UPDRS)Ⅲ in the "on" phase (SMD =-0.570, 95%CI: -0.710—0.430; P = 0.000) and in the "off" phase (SMD =-1.170, 95%CI: -1.500—0.850; P = 0.000), UPDRSⅠscore (SMD =-0.150, 95%CI: -0.290—0.010; P = 0.030), and 39-Item Parkinson's Disease Questionnaire (PDQ-39) score (SMD =-0.510, 95%CI: -0.660—0.370; P = 0.000). But it can increase the occurrence of severe adverse events (RD = 0.140, 95% CI:0.090-0.190; P = 0.000) and dysarthria (RD = 0.070, 95%CI: 0.010-0.120; P = 0.020), while decrease the occurrence of dyskinesia (RR = 0.450, 95% CI: 0.330-0.620; P = 0.000). Conclusions Subthalamic nucleus deep brain stimulation combined with drug therapy could greatly improve motor function, mental status and quality of life of PD patients, however, clinicians should pay more attention to the increased risk of severe adverse events and dysarthria after operation.

Key words: Parkinson disease, Subthalamic nucleus, Deep brain stimulation, Drug therapy, Meta-analysis