脑深部电刺激术联合药物治疗帕金森病有效性和安全性的meta分析
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李晋芳(1968-),硕士,主任医师,研究方向:帕金森。E-mail:lijinfang0331@163.com。

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重庆市科技计划项目(cstc2015shms-ztzx10009)


Efficacy and safety of deep brain stimulation combined with drug therapy in treatment of Parkinson's disease: A meta-analysis
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    摘要:

    目的 评价脑深部电刺激术联合药物治疗帕金森病的有效性及安全性。方法 检索在2018年9月之前于PubMed、EMBASE、Cochrane Library、CNKI文献数据库中DBS治疗帕金森病的临床研究。按纳入标准和排除标准进行资料筛选和提取,利用RevMan 5.3软件进行数据分析。结果 纳入11个研究共274名帕金森患者。Meta分析显示:5年单纯DBS治疗与术后5年基线差异有统计学意义(P<0.01),运动症状较术后基线改善,UPDRS-Ⅲ(SMD=-21.31,95%CI:-25.18~-17.44);术后5年单纯DBS治疗与药物联合DBS治疗差异有统计学意义(P<0.01),运动症状UPDRS-Ⅲ(SMD=-7.26,95%CI:-9.02~-5.02)、生活质量UPDRS-Ⅱ(SMD=-4.2,95%CI:-6.02~-2.82)较单纯手术治疗有改善;术前术后LEDD(SMD=453.76,95%CI:394.31~513.21)差异有统计学意义(P<0.01)。DBS副作用发生率较低,脑出血发生率4.4%,感染6例(2.2%);癫痫3例(1.1%)。结论 脑深部电刺激术在术后5年无论是单纯手术治疗或手术联合药物治疗均能改善患者的运动症状及生活质量,较术前明显降低了左旋多巴类药物的用量,且副作用少,安全性高。

    Abstract:

    Objective To systematically evaluate the efficacy and safety of deep brain stimulation (DBS) combined with drug therapy in the treatment of Parkinson's disease.Methods PubMed, EMBASE, Cochrane Library, and CNKI were searched for clinical studies on DBS in the treatment of Parkinson's disease published up to September 2018. Data screening and extraction were conducted according to inclusion and exclusion criteria, and RevMan 5.3 software was used for data analysis.Results A total of 11 studies were enrolled, with 274 patients with Parkinson's disease in total. The meta-analysis showed that the patients treated with DBS alone showed a significant improvement from the baseline at 5 years after operation (P<0.01); the motor symptoms were improved from the baseline (UPDRS-Ⅲ:standardized mean difference[SMD]=-21.31, 95% confidence interval[CI]:-25.18 to -17.44); there was a significant difference in treatment outcome between the patients treated with DBS alone and those treated with DBS combined with drug therapy at 5 years after operation (P<0.01); the patients treated with DBS combined with drug therapy showed improvements in motor symptoms (UPDRS-Ⅲ) (SMD=-7.26, 95%CI:-9.02 to-5.02) and quality of life (UPDRS-Ⅱ) (SMD=-4.2, 95%CI:-6.02 to-2.82) compared with those treated with DBS alone; the levodopa equivalent daily dose was significantly different before and after operation (SMD=453.76, 95%CI:394.31-513.21,P<0.01). DBS had a low incidence rate of side effects, and the incidence rates of cerebral hemorrhage, infection, and epilepsy were 4.4% (12 patients), 2.2% (6 patients), and 1.1% (3 patients), respectively.Conclusions DBS alone or combined with drug therapy can improve patients' motor symptoms and quality of life in 5 years after surgery and significantly reduce the dose of levodopa, with fewer side effects and high safety.

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王谑菲, 袁德智, 张晓天, 赵秋叶, 李晋芳456.脑深部电刺激术联合药物治疗帕金森病有效性和安全性的meta分析[J].国际神经病学神经外科学杂志,2019,46(4):358-363111WANG Xue-Fei, YUAN De-Zhi, ZHANG Xiao-Tian, ZHAO Qiu-Ye, LI Jin-Fang222. Efficacy and safety of deep brain stimulation combined with drug therapy in treatment of Parkinson's disease: A meta-analysis[J]. Journal of International Neurology and Neurosurgery,2019,46(4):358-363

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  • 收稿日期:2019-04-08
  • 最后修改日期:2019-06-04
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  • 在线发布日期: 2019-08-28
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