左旋多巴挑战试验可预测不同帕金森病运动亚型中 STN-DBS 的结果：更准确的判断。
Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson's Disease Motor Subtypes: A More Accurate Judgment.
机构信息
Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China.
出版信息
Neural Plast. 2021 Oct 21;2021:4762027. doi: 10.1155/2021/4762027. eCollection 2021.
BACKGROUND
The relationship between the levodopa challenge test (LDCT) and postoperative subthalamic nucleus-deep brain stimulation (STN-DBS) benefits is controversial in patients with Parkinson's disease (PD). We aim to evaluate the value of total levodopa response (TLR) and symptom levodopa response (SLR) in predicting postoperative improvement in different PD motor subtypes.
METHODS
Studies were split into a training set (147 patients) and a validation set (304 patients). We retrospectively collected data from 147 patients who received the Unified Parkinson's Disease Rating Scale- (UPDRS-) III and the Parkinson's Disease Questionnaire- (PDQ-) 39 evaluation. Patients were classified into tremor-dominant (TD), akinetic-rigid-dominant (AR), and mixed (MX) groups. Clinically important difference (CID) was employed to dichotomize DBS effects. For patients in each subtype group from the training set, we used the correlation and receiver operator characteristic (ROC) curve analyses to explore the strength of their relations. Areas under the curve (AUCs) were calculated and compared through the DeLong test. Results developed from the training set were applied into the validation set to predict postoperative improvement in different PD motor subtypes.
RESULTS
In the validation cohort, TLR significantly correlated with postoperative motor ( < 0.001) and quality of life (QOL) ( < 0.001) improvement in the MX group. The AUC between TLR and UPDRS-III (TU) is 0.800. The AUC between TLR and PDQ-39 (TP) is 0.770. An associated criterion in both TU and TP is around 50%. In the AR group, strong correlation was only found in SLR and PDQ-39 (SP) ( < 0.001). And the AUC of SP is significantly larger than that in TLR and PDQ-39 (TP) ( = 0.034). An associated criterion in SP is around 37%. No significant correlation was found in the TD group.
CONCLUSIONS
We provide a more accurate judgment for LDCT. TLR strongly correlated with postoperative UPDRS-III and PDQ-39 improvement in MX patients. A TLR > 50% may indicate a higher possibility of clinically meaningful benefits from STN-DBS comparing to medication only. SLR can well predict QOL improvement in AR patients. Similarly, a SLR > 37% may indicate a higher possibility of clinically significant benefits from STN-DBS. LDCT provides limited information for TD patients.
背景
左旋多巴挑战试验（LDCT）与术后丘脑底核深部脑刺激（STN-DBS）益处之间的关系在帕金森病（PD）患者中存在争议。我们旨在评估总左旋多巴反应（TLR）和症状左旋多巴反应（SLR）在预测不同 PD 运动亚型术后改善方面的价值。
方法
研究分为训练集（147 例患者）和验证集（304 例患者）。我们回顾性收集了 147 例接受统一帕金森病评定量表-（UPDRS-）III 和帕金森病问卷-（PDQ-）39 评估的患者的数据。患者分为震颤为主型（TD）、无动僵直为主型（AR）和混合型（MX）。采用临床重要差异（CID）将 DBS 效果分为二分类。对于训练集每个亚型组的患者，我们使用相关性和接收者操作特征（ROC）曲线分析来探讨它们之间关系的强度。通过 DeLong 检验计算并比较曲线下面积（AUCs）。从训练集中得出的结果应用于验证集，以预测不同 PD 运动亚型的术后改善。
结果
在验证队列中，TLR 与 MX 组术后运动（<0.001）和生活质量（QOL）（<0.001）的改善显著相关。TLR 与 UPDRS-III（TU）之间的 AUC 为 0.800。TLR 与 PDQ-39（TP）之间的 AUC 为 0.770。TU 和 TP 中关联标准约为 50%。在 AR 组中，仅发现 SLR 与 PDQ-39（SP）之间存在强相关性（<0.001）。SP 的 AUC 显著大于 TLR 和 PDQ-39（TP）（=0.034）。SP 中关联标准约为 37%。TD 组无显著相关性。
结论
我们为 LDCT 提供了更准确的判断。TLR 与 MX 患者术后 UPDRS-III 和 PDQ-39 改善强烈相关。TLR>50%可能表明与仅药物治疗相比，STN-DBS 具有更高的临床获益可能性。SLR 可以很好地预测 AR 患者的 QOL 改善。同样，SLR>37%可能表明与仅药物治疗相比，STN-DBS 具有更高的临床获益可能性。LDCT 为 TD 患者提供的信息有限。
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