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重新审视左旋多巴反应作为帕金森病深部脑刺激术后运动结果的预测指标

Revisiting the L-Dopa Response as a Predictor of Motor Outcomes After Deep Brain Stimulation in Parkinson's Disease.

作者信息

Lin Zhengyu, Zhang Xiaoxiao, Wang Linbin, Zhang Yingying, Zhou Haiyan, Sun Qingfang, Sun Bomin, Huang Peng, Li Dianyou

机构信息

Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Front Hum Neurosci. 2021 Feb 4;15:604433. doi: 10.3389/fnhum.2021.604433. eCollection 2021.

Abstract

To investigate the correlation between preoperative response to the L-dopa challenge test and efficacy of deep brain stimulation (DBS) on motor function in Parkinson's disease (PD). We retrospectively reviewed the data of 38 patients with idiopathic PD who underwent DBS surgery with a median follow-up duration of 7 months. Twenty underwent bilateral globus pallidus interna (GPi) DBS, and 18 underwent bilateral subthalamic nucleus (STN) DBS. The Movement Disorder Society Unified Parkinson Disease Rating Scale-Motor Part (MDS UPDRS-III) was assessed before surgery and at the last follow-up in different medication and stimulation conditions, respectively. Pearson's correlation analysis revealed a positive correlation between preoperative L-dopa challenge responsiveness and GPi-DBS responsiveness on the total score ( = 0.283, = 0.016) but not on the non-tremor total score ( = 0.158, = 0.083) of MDS UPDRS-III. Such correlation remained significant ( ' = 0.332, = 0.010) after controlling for age at the time of surgery as confounding factor by partial correlation analysis. The preoperative L-dopa challenge responsiveness was significantly correlated with the tremor-controlling outcome of GPi-DBS ( = 0.390, = 0.003). In contrast, we found a positive correlation between preoperative L-dopa challenge responsiveness and STN-DBS responsiveness on the non-tremor total score ( = 0.290, = 0.021), but not on the total score ( = 0.130, = 0.141) of MDS UPDRS-III. The partial correlation analysis further demonstrated that the predictive value of preoperative L-dopa challenge responsiveness on the non-tremor motor outcome of STN-DBS was eliminated ( ' = 0.120, = 0.174) after controlling for age at the time of surgery as confounding factor. The short-term predictive value of preoperative response to the L-dopa challenge test for the motor outcome of GPi-DBS in PD was systematically described. Our findings suggest: (1) a solid therapeutic effect of GPi-DBS in treating L-dopa-responsive tremors; (2) a negative effect of age at the time of surgery on motor outcomes of STN-DBS, (3) a possible preference of STN- to GPi-DBS in L-dopa-resistant tremor control, and (4) a possible preference of GPi- to STN-DBS in elderly PD patients who have a satisfactory dopamine response.

摘要

探讨帕金森病(PD)患者术前左旋多巴冲击试验反应与脑深部电刺激(DBS)对运动功能疗效之间的相关性。我们回顾性分析了38例特发性PD患者的数据,这些患者接受了DBS手术,中位随访时间为7个月。其中20例行双侧内侧苍白球(GPi)DBS,18例行双侧丘脑底核(STN)DBS。分别在术前以及末次随访时,于不同药物和刺激条件下评估运动障碍协会统一帕金森病评定量表-运动部分(MDS UPDRS-III)。Pearson相关性分析显示,术前左旋多巴冲击反应性与GPi-DBS对MDS UPDRS-III总分的反应性呈正相关(r = 0.283,P = 0.016),但与非震颤总分的反应性无相关性(r = 0.158,P = 0.083)。通过偏相关分析将手术时年龄作为混杂因素进行控制后,这种相关性仍然显著(r’ = 0.332,P = 0.010)。术前左旋多巴冲击反应性与GPi-DBS的震颤控制效果显著相关(r = 0.390,P = 0.003)。相比之下,我们发现术前左旋多巴冲击反应性与STN-DBS对MDS UPDRS-III非震颤总分的反应性呈正相关(r = 0.290,P = 0.021),但与总分的反应性无相关性(r = 0.130,P = 0.141)。偏相关分析进一步表明,将手术时年龄作为混杂因素进行控制后,术前左旋多巴冲击反应性对STN-DBS非震颤运动结局的预测价值消失(r’ = 0.120,P = 0.174)。系统描述了术前左旋多巴冲击试验反应对PD患者GPi-DBS运动结局的短期预测价值。我们的研究结果表明:(1)GPi-DBS在治疗左旋多巴反应性震颤方面具有确切疗效;(2)手术时年龄对STN-DBS的运动结局有负面影响;(3)在控制左旋多巴抵抗性震颤方面,STN-DBS可能比GPi-DBS更具优势;(4)在多巴胺反应良好的老年PD患者中,GPi-DBS可能比STN-DBS更具优势。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/24ad/7889513/46e0fdcf40b3/fnhum-15-604433-g001.jpg

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