摘要
目的研究PD患者心血管自主神经功能障碍,并探讨其可能影响因素。方法抽样选取2017年10月至2018年12月于贵州医科大学附属医院神经内科住院PD患者70例。收集所有患者的一般资料、Hoehn-Yahr分期(H-Y分期)、统一帕金森病评定量表Ⅲ(UPDRSⅢ)评分、自主神经评定量表(SCOPA-AUT)评分,以及24 h动态心电图、24 h动态血压及交感神经皮肤反应(SSR)检查资料。对心率变异性(HRV)相关指标与一般资料及量表评分行相关性分析,血压变异性相关指标与一般资料及量表评分行多因素Logistic回归分析,以探讨影响PD患者心率变异及血压变异的影响因素;对PD患者SSR与HRV相关数据行相关性分析,比较PD患者SSR异常者与SSR正常者血压变异性分布差异,以探讨SSR与心血管自主神经功能障碍之间关系。结果70例PD患者HRV中24 h全部窦性心搏RR间期的标准差(SDNN)与病程(r=-0.49,P=0.028)、左旋多巴等效剂量(LED,r=-0.46,P=0.039)、H-Y分期(r=-0.66,P=0.002)、UPDRSⅢ量表评分(r=-0.52,P=0.018)呈负相关。单因素分析结果显示,PD中患神经源性直立性低血压(nOH)与病程(χ^2=5.23,P=0.022)、H-Y分期(χ^2=7.48,P=0.024)有关,患餐后低血压(PPH)与病程(χ^2=10.12,P=0.001)、LED(χ^2=6.58,P=0.010)及UPDRSⅢ量表评分(χ^2=10.93,P=0.001)有关,患卧位高血压(SH)与病程(χ^2=12.48,P<0.001)、H-Y分期(χ^2=23.54,P<0.001)及UPDRSⅢ量表评分(χ^2=17.28,P<0.001)有关,差异有统计学意义;进一步多因素Logistic回归分析显示PD患者病程(OR=24.896,P=0.000)及UPDRSⅢ量表评分(OR=9.663,P=0.022)是心血管自主神经功能障碍的独立影响因素。SSR与HRV各指标无相关性。SSR异常者nOH〔上肢χ^2=4.84,P=0.028;下肢χ^2=4.73,P=0.030〕、PPH〔上肢χ^2=3.95,P=0.047;下肢χ^2=4.16,P=0.041〕、SH〔上肢χ^2=6.08,P=0.014〕患病率更高。结论PD患者存在心血管自主神经功能障碍,且HRV及血压变异性与病程、疾病严重程度及运动症状严重程
Objective This study aimed to investigate cardiovascular autonomic dysfunction in patients with Parkinson's disease(PD)and explore its possible influencing factors.Methods A sample of 70 patients with PD who were hospitalized in the Department of Neurology,Affiliated Hospital of Guizhou Medical University from October 2017 to December 2018 were selected.The general data,Hoehn and Yahr Staging(H-Y staging),score of Unified Parkinson's Disease Rating ScaleⅢ(UPDRSⅢ),score of the scale for outcomes in PD for autonomic symptoms(SCOPA-AUT),24-hour Holter and 24-hour ambulatory blood pressure,and sympathetic skin response(SSR)of all the patients were collected.Correlation analyses of heart rate variability(HRV)-related indices,general data,and scale scores and multi-factor logistic regression analysis of blood pressure variability-related indices,general data,and scale scores were conducted to explore factors influencing HRV and blood pressure variability in patients with PD.Correlation analyses of SSR and HRV-related data wereperformed,and blood pressure variability distribution was compared between patients with abnormal SSR and normal SSR to explore the relationship between SSR and cardiovascular autonomic dysfunction.Results For the HRV of 70 patients with PD,the 24-hour standard deviation of NN intervals(SDNN)was negatively correlated with disease course(r=-0.49,P=0.028),levodopa equivalent dose(LED,r=-0.46,P=0.039),H-Y staging(r=-0.66,P=0.002),and UPDRSⅢscale scores(r=-0.52,P=0.018).Univariate analysis showed that neurogenic orthostatic hypotension(nOH)was releted toH-Y staging(2=7.48,P=0.024)and disease course(2=5.23,P=0.022),postprandial hypotension(PPH)was associated withLED(2=6.58,P=0.010),UPDRSⅢscale score(2=10.93,P=0.001),and disease course(2=10.12,P=0.001).In addition,supine hypertension(SH)was associated with H-Y staging(2=23.54,P<0.001),UPDRSⅢscale score(2=17.28,P<0.001),and disease course(2=12.48,P<0.001).Further multivariate logistic regression analysis showed that the disease duration(OR=24.8
作者
陆胤
焦玲
刘伟民
LU Yin;JIAO Ling;LIU Weimin(不详;Department of Neurology,Guizhou Medical University,Guiyang Guizhou 550001,China)
出处
《中国神经免疫学和神经病学杂志》
CAS
北大核心
2020年第6期453-459,共7页
Chinese Journal of Neuroimmunology and Neurology
基金
传染病预防控制国家重点实验开放课题(2018SKLID307)
贵阳市科技局合作项目筑科合同([2017]30-30)。
关键词
帕金森病
心血管自主神经功能障碍
心率变异性
血压变异性
交感神经皮肤反应
Parkinson's disease
cardiovascular autonomic nervous dysfunction
heart rate variability
blood pressure variability
sympathetic skin response
