Predictors to quality of life improvements after subthalamic stimulation in Parkinson's disease
Predictors to quality of life improvements after subthalamic stimulation in Parkinson's disease
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帕金森病患者丘脑底刺激后生活质量改善的预测因子
DOI：
10.1111/ane.13056
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发表时间：
2019-04-01
影响因子：
3.5
通讯作者：
Wu, Jian-Jun
中科院分区：
文献类型：
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作者：
Liu, Feng-Tao;Lang, Li-Qin;Wu, Jian-Jun
据报道，下丘脑深部脑刺激（STN DBS）可以改善帕金森病（PD）相关的生活质量（QoL）。然而，并非所有受试者都对术后生活质量满意。我们的目的是检测STN DBS后1年PD患者生活质量改善的相关因素和可能的预测因素。材料与方法选取45例PD双侧STN DBS手术患者，随访1年。采用可靠变化指数（RCI）来确定个体术后生活质量结果。生活质量的变化与基线参数和进展参数的变化采用Pearson相关分析。采用探索性逐步回归来检测基线变量和进展参数的程度。采用logistic回归分析检测影响生活质量的因素。结果51.1%的患者生活质量改善，40.0%的患者生活质量保持不变，8.9%的患者生活质量恶化。运动能力、日常生活活动、认知和身体不适的子域在手术后显著改善。术前因素包括生活质量、多巴胺能药物负担、疾病分期、抑郁评分、术后抑郁和非运动评分的减少与生活质量的变化相关。此外，更大的术前生活质量负担、更少的多巴胺能药物暴露和更早的疾病阶段是生活质量改善的预测因素。结论临床医生应在较早的阶段和较低的用药剂量下仔细评估患者的非运动症状和生活质量，以获得较好的DBS治疗效果。
Introduction Subthalamic deep brain stimulation (STN DBS) has been reported to improve the quality of life (QoL) related to Parkinson's disease (PD). However, not all subjects are satisfied with the postsurgical QoL outcome. We aimed to detect the related factors and possible predictors to QoL improvement for those PD patients one year after STN DBS. Materials and Methods A total of 45 PD patients with bilateral STN DBS surgery were included and followed up for 1 year. The Reliable Change Index (RCI) was adapted to determine the individual postsurgical QoL outcome. The changes of QoL were correlated with baseline parameters and the changes of progression parameters using Pearson's correlation. The exploratory stepwise regressions were adopted to detect the extents of baseline variables and progression parameters. The predictors to QoL outcome were detected using the logistic regression analysis. Results A total of 51.1% of the patients reported a better QoL, 40.0% of patients reported an unchanged QoL, while 8.9% of patients reported a worsening of QoL. The subdomains of mobility, activity of daily living, cognition, and bodily discomfort improved significantly after the surgery. The presurgical factors including QoL, dopaminergic medication burden, disease stages, depression scores, and postsurgical reductions in depression and nonmotor scores were found to correlate with QoL changes. Furthermore, the greater presurgical QoL burden, lesser dopaminergic medication exposure, and earlier disease stages were predictors to QoL improvements. Conclusion The clinicians should carefully evaluate the nonmotor symptoms and life quality in those patients at relatively earlier stages and with lower medicine dosage to get more successful DBS outcomes.