纤维蛋白原是磁共振引导聚焦超声丘脑切开术后震颤缓解和复发的关键因素

IF 1.8 Q3 CLINICAL NEUROLOGY

Clinical Parkinsonism Related Disorders Pub Date : 2025-01-01 DOI:10.1016/j.prdoa.2025.100376

Jiaji Lin , Haoxuan Lu , Xianbing Bian , Jianxing Hu , Longsheng Pan , Xin Lou

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引用次数: 0

摘要

磁共振引导的聚焦超声（MRgFUS）丘脑切开术对于特发性震颤（ET）等震颤疾病是安全有效的，但术前血清是否介导治疗后震颤复发还有待进一步研究。方法回顾性分析2018-2020年接受单侧MRgFUS丘脑切除术的59例ET患者的资料。停药后使用震颤临床评定量表（CRST）评估震颤严重程度，并通过衍生的CRST子量表测量对侧手震颤。短期震颤缓解定义为术后1个月内震颤减轻≥50%，震颤复发定义为12个月内恶化25%且至少8点。进行多因素logistic回归分析，以确定震颤缓解和复发的预测因素，以及P和lt的变量；0.05为构建震颤缓解和复发的图。采用受者工作特性曲线、校正分析和Hosmer-Lemeshow检验来评价其模态图。结果MRgFUS丘脑切除术后1个月，手部震颤评分下降了>；所有患者与术前评分相比的50%；39例（66.10%）患者中75%。然而，9例（15.25%）患者在12个月内发生震颤复发。多因素分析显示，纤维蛋白原与短期震颤缓解（比值比[OR]: 0.18）和长期震颤复发（比值比[OR]: 1.620）独立相关。震颤缓解和复发的图表现出较高的性能（曲线下面积分别为0.82和0.83）；Hosmer-Lemeshow检验的P值分别为0.54和0.498。标定曲线具有较高的一致性。结论血清纤维蛋白原是单侧MRgFUS丘脑切除术患者震颤缓解和复发的关键因素。

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Fibrinogen is the key factor associated with tremor relief and recurrence after magnetic resonance-guided focused ultrasound thalamotomy

Introduction

Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is safe and effective for tremor disorders such as essential tremor (ET), but whether preoperative serum profiles mediate tremor recurrence after treatment requires further investigation.

Methods

We retrospectively analyzed the data of 59 ET patients who underwent unilateral MRgFUS thalamotomy during 2018–2020. Tremor severity was assessed off-medication using the Clinical Rating Scale for Tremor (CRST), with contralateral hand tremor measured via a derived CRST subscale. Short-term tremor relief was defined as ≥ 50 % reduction at 1-month postoperatively, and tremor recurrence was defined as a worsening by 25 % and at least 8 points within 12 months. Multivariate logistic regression analyses were performed to identify predictors of tremor relief and recurrence, and variables with P < 0.05 were used to construct nomograms for tremor relief and recurrence. Receiver operating characteristic curves, calibration analysis, and the Hosmer-Lemeshow test were conducted to evaluate the nomograms.

Results

At 1-month after MRgFUS thalamotomy, hand tremor scores were decreased by > 50 % relative to the preoperative score in all patients and by > 75 % in 39 (66.10 %) patients. However, 9 (15.25 %) patients developed tremor recurrence within 12 months. Multivariate analysis showed that fibrinogen was independently linked to short-term tremor relief (odds ratio [OR]: 0.18) and long-term tremor recurrence (OR: 1.620). The nomograms for tremor relief and recurrence showed high performance (areas under the curve: 0.82 and 0.83, respectively); the Hosmer-Lemeshow test yielded P values of 0.54 and 0.498, respectively. The calibration curves exhibited high consistency.