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目的探讨帕金森病患者丘脑腹外侧核(VL)、内侧苍白球(GPi)和丘脑底核(STN)神经元电活动特点与帕金森症状的关系。方法27例帕金森病患者(男17例,女10例)接受了立体定向毁损术治疗,手术靶点分别为:VL(10例)、GPi(10例)和STN(7例)。术中应用微电极和肌电(EMG)记录技术同时记录神经元电活动和手术对侧肢体EMG。术前和术后采用帕金森综合评分表(UPDRS)对患者“关”状态的运动功能进行比较。通过单细胞分析方法甄别细胞电活动特点,相关性检验探讨细胞电活动与肢体EMG的关系,同时运用方差分析比较3个核团不同放电模式神经元的数量和帕金森病三大主症的改善。结果从27个针道中甄别出361个神经元,其主要放电模式是:与震颤相关的放电活动(159个)、高频紧张性放电活动(134个)和不规则放电活动(68个)。其中与震颤相关的簇状放电节律和肢体震颤有相关性(P<0·01)。方差分析显示VL中与震颤相关的细胞数量与其他两个核团相比差异有统计学意义(VL:9·0个/针道、GPi:4·9个/针道和STN:3·0个/针道)(均P<0·05),STN中不规则放电神经元的数量与其他两个核团相比差异有统计学意义(VL:1·4个/针道、GPi:2·8个/针道和STN:3·7个/针道)(均P<0·05),而紧张性放电神经元的数量(VL:4·2个/针道、GPi:6·2个/针道和STN:4·3个/针道)差异无统计学意义(均P>0·05)。术后手术对侧肢体的UPDRS评分显示VL、GPi和STN对震颤的改善率分别为91·7%、84·8%和62·7%,对行动迟缓的改善率为36·9%、62·3%和70·8%,对僵直的改善率为56·2%、71·3%和68·8%。方差分析结果显示震颤和行动迟缓的改善率比较差异有统计学意义(P<0·01),其中VL对震颤的改善效果最好,而STN对行动迟缓的改善最明显;但是3个核团对僵直的改善差异无统计学意义(均P>0·05)。结论VL、GPi和STN中不同的神经元放电模式可能与帕金森病临床症状有内在联系,这为不同症状为主的帕金森病患者选择最佳手术靶点提供了依据。
Objective To investigate the relationship between the electrical activity of Parkinson’s disease neurons in the ventromedial nucleus (VL), the medial pallidus (GPi) and the subthalamic nucleus (STN) and the Parkinson’s disease. Methods Twenty-seven patients with Parkinson’s disease (17 males and 10 females) received stereotactic destructive surgery. The targets of surgery were VL (10 cases), GPi (10 cases) and STN (7 cases). Intraoperative use of microelectrodes and electromyography (EMG) recording technology to simultaneously record the electrical activity of the neurons and the contralateral limb EMG. Preoperative and postoperative Parkinson’s score (UPDRS) were used to compare motor function in patients with “off” status. The single cell analysis method was used to identify the characteristics of cellular electrical activity. The correlation test was used to investigate the relationship between cellular electrical activity and limb EMG. At the same time, the variance analysis was used to compare the number of neurons in three different nuclear discharge modes and the improvement of the three main symptoms of Parkinson’s disease . Results 361 neurons were identified from 27 needle paths. The main discharge patterns were: tremor-related discharge activity (159), high-frequency tension discharge activity (134) and irregular discharge activity (68). There was a correlation between tremor-related cluster-like discharge rhythms and limb tremor (P <0.01). Analysis of variance showed that the number of tremor-related cells in VL was statistically different from the other two nuclei (VL: 9.0 / needle track, GPi: 4.9 / needle track and STN: 3.0 (P <0.05). The number of irregular discharge neurons in STN was significantly different from that in the other two nuclei (VL: 1.4 / needle track, GPi: 2 · 8 / needle and STN: 3.7 · needle / needle) (all P <0.05), whereas the number of tensioned neurons (VL: 4.2 / needle track, GPi: 6.2 / Needle track and STN: 4.3 / needle track) had no significant difference (all P> 0.05). The UPDRS scores of the contralateral limbs after operation showed that the improvement rates of tremor for VL, GPi and STN were 91.7%, 84.8% and 62.7%, respectively, while the improvement rate to bradykinesia was 36.9%, 62 · 3% and 70 · 8% respectively, and the improvement rates of rigidity were 56.2%, 71.3% and 68.8% respectively. Analysis of variance showed that there was significant difference in improvement rate of tremor and bradykinesia (P <0.01), among which VL had the best improvement on tremor and STN had the most obvious improvement on bradykinesia; however, three nuclei There was no significant difference in the improvement of stiffness (P> 0.05). Conclusion Different patterns of neuronal discharge in VL, GPi and STN may be related to the clinical symptoms of Parkinson’s disease. This provides a basis for selecting the best surgical target for Parkinson’s disease with different symptoms.