医学信息
醫學信息
의학신식
MEDICAL INFORMATION
2014年
13期
107-108
,共2页
脑深部电刺激术%帕金森病%丘脑底核%苍白球
腦深部電刺激術%帕金森病%丘腦底覈%蒼白毬
뇌심부전자격술%파금삼병%구뇌저핵%창백구
Deep brain stimulation%Parkinson disease%Subthalamic nucleus%Globus pal idus
随着人口老龄化，帕金森病（PD）已成为影响人类生存质量的重要疾病，尤其对于晚期PD患者，其药效降低，副作用增加。脑深部电刺激术（Deep Brain Stimulation，DBS）是近年发展起来的一种新型治疗方法，它能够改善晚期PD运动症状（MS）和非运动症状（NMS），提高患者生存质量。目前广泛应用的DBS靶点为丘脑底核（STN）和苍白球内侧部（GPi），然而STN-DBS应用更加广泛，原因可能为仅STN-DBS能明显减少术后患者每日服用多巴胺等效剂量（Levodpa Equivalent Dose，LED）。多项国外临床试验证明STN-DBS和GPi-DBS在运动症状改善方面无明显差异，但在许多非运动症状上面，GPi-DBS亦可能存在微弱优势。同时，在不断明确STN与GPi的差异下，也应严格规定手术纳入标准，并明确不同患者之间的差异，在保证疗效的情况下，逐渐趋于个性化治疗，为患者追求更大手术收益。因此，患者的选择也是DBS中重要的一部分。本综述结合国内外最新研究进展，着重讨论以上方面。
隨著人口老齡化，帕金森病（PD）已成為影響人類生存質量的重要疾病，尤其對于晚期PD患者，其藥效降低，副作用增加。腦深部電刺激術（Deep Brain Stimulation，DBS）是近年髮展起來的一種新型治療方法，它能夠改善晚期PD運動癥狀（MS）和非運動癥狀（NMS），提高患者生存質量。目前廣汎應用的DBS靶點為丘腦底覈（STN）和蒼白毬內側部（GPi），然而STN-DBS應用更加廣汎，原因可能為僅STN-DBS能明顯減少術後患者每日服用多巴胺等效劑量（Levodpa Equivalent Dose，LED）。多項國外臨床試驗證明STN-DBS和GPi-DBS在運動癥狀改善方麵無明顯差異，但在許多非運動癥狀上麵，GPi-DBS亦可能存在微弱優勢。同時，在不斷明確STN與GPi的差異下，也應嚴格規定手術納入標準，併明確不同患者之間的差異，在保證療效的情況下，逐漸趨于箇性化治療，為患者追求更大手術收益。因此，患者的選擇也是DBS中重要的一部分。本綜述結閤國內外最新研究進展，著重討論以上方麵。
수착인구노령화，파금삼병（PD）이성위영향인류생존질량적중요질병，우기대우만기PD환자，기약효강저，부작용증가。뇌심부전자격술（Deep Brain Stimulation，DBS）시근년발전기래적일충신형치료방법，타능구개선만기PD운동증상（MS）화비운동증상（NMS），제고환자생존질량。목전엄범응용적DBS파점위구뇌저핵（STN）화창백구내측부（GPi），연이STN-DBS응용경가엄범，원인가능위부STN-DBS능명현감소술후환자매일복용다파알등효제량（Levodpa Equivalent Dose，LED）。다항국외림상시험증명STN-DBS화GPi-DBS재운동증상개선방면무명현차이，단재허다비운동증상상면，GPi-DBS역가능존재미약우세。동시，재불단명학STN여GPi적차이하，야응엄격규정수술납입표준，병명학불동환자지간적차이，재보증료효적정황하，축점추우개성화치료，위환자추구경대수술수익。인차，환자적선택야시DBS중중요적일부분。본종술결합국내외최신연구진전，착중토론이상방면。
As the population ages, Parkinson's disease (PD) has become a disease severely af ecting the quality of the patients' life, especial y for those with advanced PD whose ef icacy of dopaminergic drugs decreases, while the side ef ects also increases. Deep Brain Stimulation (DBS) is an alternative way of treatment which developed in recent years. It can improve both the motor symptoms(MS) and the non-motor symptoms(NMS), thus improving the quality of life. The current widely used DBS targets are subthalamic nuclei (STN) and the globus pal idus interna (GPi). However, the STN-DBS seems to be more widely used, and this fact may be at ributed to the obvious reduction of the daily levadopa equivalent dose (LED) induced by STN-DBS. Many recent international clinical trials support that the STN DBS and GPi - DBS has no obvious dif erence in motor symptoms, but they dif er in several mild dif erences in non-motor symptoms, which may indicate some potential advantages of GPi - DBS. Meanwhile, with the dif erences between the STN and GPi clearing, the inclusive and exclusive criteria for the patients who tend to have DBS should be strictly ruled, the dif erences between patients should be individualized, then the individual therapy could be realized which would benefit the patients with advanced PD further. Therefore, the inclusive and exclusive criteria for PD patients is also an important part of DBS. Combined with the latest researchs in the field of DBS for PD, this clinical review focuses on the aspects above.
