CAJ | 학술논문

目的：分析不同类型帕金森病（PD ）患者双侧丘脑底核（STN ）深部电刺激（DBS ）术后的长期疗效。方法选择行双侧STN －DBS治疗的49例原发性PD患者，其中男27例，女22例；年龄平均（56．8±9．4）岁；病程平均（8．2±4．1）年。采用PD统一评分量表（UPDRS）分别在术前关期、开期和术后关期、开期对患者进行疗效评估。根据术前关期U PDRSⅢ的震颤评分和非震颤评分将患者分为震颤型、僵直迟缓型和混合型3组。应用配对 t检验比较3组患者术前和术后的U PDRS评分。结果术后平均随访时间为（4．8±1．4）年。关期 PD患者的UPDRSⅢ运动改善率为50．8％，UPDRSⅡ日常生活能力改善率为32．9％。其中僵直迟缓型患者术后日常生活能力提高（ P＜0．05），僵直迟缓型和混合型患者术后U PDRSⅢ总分及各分项评分（震颤、僵直、迟缓、姿势稳定性和步态障碍）均改善（ P ＜0.05）；震颤型患者术后震颤症状改善（P ＜0．05）。僵直迟缓型患者术后异动症持续时间减少，异动症病残程度降低（P ＜0．05）。3组患者术后多巴胺类药物日摄入剂量均较术前减少（P＜0．05）。长期疗效分析显示部分僵直迟缓型和混合型患者吞咽障碍、语言障碍加重（P ＜0．05）。3组患者的刺激脉宽、频率和电压差异无统计学意义（P ＞0．05）。结论双侧STN －DBS可以长期有效改善不同症状类型PD患者的运动症状和异动症，减少多巴胺类药物的日摄入剂量，但对于部分病程进展较快的僵直迟缓型和混合型患者，STN －DBS不能有效改善吞咽障碍、语言障碍等中线症状。
목적：분석불동류형파금삼병（PD ）환자쌍측구뇌저핵（STN ）심부전자격（DBS ）술후적장기료효。방법선택행쌍측STN －DBS치료적49례원발성PD환자，기중남27례，녀22례；년령평균（56．8±9．4）세；병정평균（8．2±4．1）년。채용PD통일평분량표（UPDRS）분별재술전관기、개기화술후관기、개기대환자진행료효평고。근거술전관기U PDRSⅢ적진전평분화비진전평분장환자분위진전형、강직지완형화혼합형3조。응용배대 t검험비교3조환자술전화술후적U PDRS평분。결과술후평균수방시간위（4．8±1．4）년。관기 PD환자적UPDRSⅢ운동개선솔위50．8％，UPDRSⅡ일상생활능력개선솔위32．9％。기중강직지완형환자술후일상생활능력제고（ P＜0．05），강직지완형화혼합형환자술후U PDRSⅢ총분급각분항평분（진전、강직、지완、자세은정성화보태장애）균개선（ P ＜0.05）；진전형환자술후진전증상개선（P ＜0．05）。강직지완형환자술후이동증지속시간감소，이동증병잔정도강저（P ＜0．05）。3조환자술후다파알류약물일섭입제량균교술전감소（P＜0．05）。장기료효분석현시부분강직지완형화혼합형환자탄인장애、어언장애가중（P ＜0．05）。3조환자적자격맥관、빈솔화전압차이무통계학의의（P ＞0．05）。결론쌍측STN －DBS가이장기유효개선불동증상류형PD환자적운동증상화이동증，감소다파알류약물적일섭입제량，단대우부분병정진전교쾌적강직지완형화혼합형환자，STN －DBS불능유효개선탄인장애、어언장애등중선증상。
Objective To assess the long -term efficacy of deep brain stimulation (DBS) in bilater‐al subthalamic nucleus(STN) with different subtypes of Parkinson disease(PD) .Methods A total of 49 cases of idiopathic PD patients treated with bilateral STN -DBS ,including 27 males and 22 females were analyzed .The average age was (56 .8 ± 9 .4) years old and the mean disease duration was (8 .2 ± 4 .1) years .Unified Parkinson's Disease Rating Scale (UPDRS) was assessed in on and off period before and after STN -DBS .Based on the UPDRS Ⅲ tremor and non -tremor scores in preoperative off period , patients were divided into tremor -dominant type (TDT ) ,rigidity slow type (ART ) ,and mixed type (MT) preoperatively .Paired t test was carried out to compare the UPDRS scores with preoperative and postoperative patients in three subtypes .Results After (4 .8 ± 1 .4) average years of follow up ,for all patients in off period ,UPDRS Ⅲ sports improvement rate was 50 .8% ,UPDRS Ⅱ daily life ability im‐provement rate was 32 .9% .Postoperative daily living of rigidity slow patients significantly increased (P < 0 .05);UPDRS Ⅲ score and each item score including tremor ,rigidity ,slow ,postural stability and gait disturbance were significantly improved after surgery in rigidity slow and mixed patients (P <0.05) .In particular ,tremor symptoms were obviously improved in tremor patients (P< 0 .05) .The du‐ration of dyskinesia reduced significantly and degree of disability decreased in rigidity slow patients after surgery ,the difference was statistically significant (P < 0 .05) .The daily intake dose of dopamine was reduced than preoperative in three types of patients .However ,long -term efficacy analysis showed that swallowing disorders ,language barriers were getting worsen in part of rigidity slow and mixed patients (P < 0 .05) .Stimulation pulse width ,frequency and voltage in three groups had no obvious difference . Conclusions Bilateral STN -DBS can effectively improve the motor symptoms and dyskinesia with dif‐ferent types of PD patients over a long period ,and reduce the daily doses of dopamine drugs .But for some rigidity slow and mixed patients with rapid progression ,STN -DBS cannot effectively improve the symptoms of dysphagia and language barrier .