帕金森病患者丘脑底核脑深部电刺激（STN-DBS）后的长期死亡率：一项生存分析
Long-Term Mortality Following STN-DBS in Parkinson's Disease: A Survival Analysis
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中文总结 AI 辅助
本研究通过对214例接受STN-DBS的PD患者进行生存分析，发现植入时年龄≥60岁增加死亡风险，翻修手术降低风险，患者满意度高，支持年龄分层选患者及术后长期监测。
中文摘要 AI 辅助
背景：丘脑底核脑深部电刺激（STN-DBS）是一种已确立的帕金森病（PD）治疗方法，可改善运动症状和生活质量，但长期生存及死亡风险仍未明确。本研究评估了STN-DBS术后的长期生存情况及与死亡相关的因素。方法：对214例接受STN-DBS的PD患者进行回顾性生存分析，采用Kaplan-Meier法估计生存概率和中位生存期，用log-rank检验比较不同性别、植入年龄患者的生存差异；Cox比例风险（Cox-PH）模型通过单变量和多变量分析确定与死亡相关的因素，并使用加速失效时间（AFT）模型验证。结果：死亡率逐步上升，分别有8.0%、42.5%和56.0%的患者在术后5年、10年和15年内死亡；中位生存期约为134个月。不同性别患者的生存无差异（p=0.63），但植入时年龄≥60岁的患者生存显著更差（p<0.0001）。至少一次术后翻修可降低死亡风险（风险比HR=0.296，p<0.001），而植入时年龄≥60岁会增加死亡风险（HR=4.689，p<0.001）；上述两个因素在校正后仍具有显著性，且经AFT模型验证。患者满意度较高，在接受调查的52例患者中，97%报告满意，96%会推荐STN-DBS。结论：STN-DBS与PD患者的长期生存及高满意度相关，植入时年龄较大增加死亡风险，而翻修手术与死亡可能反映适应症混杂而非直接因果效应。这些发现支持按年龄分层选择患者，并强调STN-DBS术后持续长期监测的重要性。
英文摘要
Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an established PD treatment that improves motor symptoms and quality of life, but long-term survival and mortality risk remain poorly characterized. This study evaluated long-term survival and mortality-associated factors after STN-DBS. Methods: A retrospective survival analysis of 214 PD patients who underwent STN-DBS used Kaplan-Meier methods to estimate survival probabilities and median survival, with log-rank tests comparing survival by gender and age at implantation. Cox proportional hazards (Cox-PH) models identified mortality-associated factors in both univariate and multivariate analyses, and were validated using accelerated failure time (AFT) models. Results: Mortality rose progressively, with 8.0%, 42.5%, and 56.0% of patients dying within 5, 10, and 15 years, respectively; median survival was approximately 134 months. Survival did not differ by gender (p = 0.63) but was significantly lower for patients aged 60 years or older at implantation (p < 0.0001). At least one post-implantation revision reduced mortality risk (HR = 0.296, p < 0.001), while implantation at age 60 years or older increased it (HR = 4.689, p < 0.001); both remained significant after adjustment and were confirmed by AFT models. Patient satisfaction was high, with 97% of 52 surveyed patients reporting satisfaction and 96% would recommend STN-DBS. Conclusion: STN-DBS is linked to long-term survival and high patient satisfaction in individuals with PD. Older age at implantation increased mortality risk, whereas revision surgery and mortality likely reflect confounding by indication rather than a direct causal effect. These findings support age-stratified patient selection and highlight the importance of continued long-term monitoring following STN-DBS.
