摘要
目的通过比较24 h心率变异指标以及24 h动态血压的差别,探讨不同运动亚型帕金森病(PD)患者心血管自主神经功能障碍的程度。方法收集2018年1月至2020年1月浙江医院收治的PD患者33例,应用运动障碍疾病协会修订统一帕金森病评定量表(MDS-UPDRS)第三部分评估患者的运动功能,将其分为震颤为主(TD)+混合型和姿势不稳步态障碍(PIGD)型两个亚组。另外选取健康者33例为对照组。各组都进行24 h动态心电图和24 h动态血压监测,比较PD组与对照组之间以及两个亚组之间以下指标的差异:(1)心率变异(HRV)频域指标:包括极低频(VLF)、低频(LF)、高频(HF)、低频/高频(LF/HF);(2)HRV时域指标:包括平均正常-正常(NN)时间间隔,NN间隔的标准偏差(SDNN),平均NN间隔的标准偏差(SDANN),连续NN间隔的标准偏差(ASDNN)、相邻NN间期差值的均方差(rMSSD)、NN间隔占NN间隔总数的比例超过50 ms的比率(Pnn50);(3)24 h血压和心率各项指标的差异。结果与对照组比较,PD组SDNN、ASDNN均明显下降(t=-2.462、-3.461,P<0.05),VLF、LF、HF、LF/HF均明显降低(t=-2.919、-3.317、-2.430、-2.217,P<0.05),差异均具有统计学意义;PD组夜间心率(nHR)、24小时心率(24hHR)较对照组明显升高,差异有统计学意义(t=3.133、2.251,P<0.05)。TD+混合型组与PIGD组比较,PIGD组在SDNN、SDANN、ASDNN、rMSSD、Pnn50指标上均较TD+混合型组降低,但差异无统计学意义;PIGD组的VLF较TD+混合型组降低,差异有统计学意义(t=2.456,P<0.05);TD+混合型组的nDBP较PIGD组明显升高,差异有统计学意义(t=2.780,P<0.05)。结论PD两种运动亚型的心率变异指标有较大差异,说明PIGD型PD患者的自主神经调节功能障碍程度较TD及混合型严重,指导临床上利用心率变异指标评估PD不同亚型患者的自主神经功能障碍程度。
Objective To explore the degree of the cardiovascular autonomic nerve dysfunction in Parkinson’s disease(PD)patients with different motor subtypes by comparing the differences of 24 h heart rate variability and 24 h ambulatory blood pressure.Methods A total of 33 PD patients admitted to Zhejiang Hospital from January 2018 to January 2020 were collected.The third part of the unified Parkinson’s disease rating scale(MDS-UPDRS)revised by the Movement Disorder Association was used to assess the motor function of patients.They were divided into tremor dominant(TD)+indeterminate and postural instability gait disorders(PIGD)two sub-groups.In addition,33 healthy controls were selected as the control group.Each group was subjected to 24-hour dynamic electrocardiogram and 24-hour ambulatory blood pressure monitoring to compare the differences in the following observation indicators between the PD group and the control group,as well as the two subgroups:(1)Heart rate variability(HRV)frequency domain indicators:including very low frequency(VLF),low frequency(LF),high frequency(HF),low frequency/high frequency(LF/HF);(2)HRVtime domain indicators:including average normal-normal(NN)time interval,standard deviation of NN interval(SDNN),standard deviation of average NN interval(SDANN),standard deviation of consecutive NN intervals(ASDNN),adjacent NN interval The mean square error of the difference(r MSSD),the ratio of NN intervals to the total number of NN intervals exceeds 50 ms(Pnn50);(3)The differences in 24 h blood pressure and heart rate indicators.Results Compared with the control group,SDNN and ASDNN were significantly decreased in the PD group(t=-2.462,-3.461;P<0.05),and VLF,LF,HF,and LF/HF were significantly decreased(t=-2.919,-3.317,-2.430,-2.217;P<0.05);the PD group’s night heart rate(n HR),24-hour heart rate(24 h HR)were significantly higher than those in the control group,the differences were statistically significant(t=3.133,2.251;P<0.05).Comparing the TD+indeterminate group with the PIGD group,the PIGD group
作者
蔡苗
王晏雯
楼跃
乔松
刘小利
Cai Miao;Wang Yanwen;Lou Yue;Qiao Song;Liu Xiaoli(Department of Neurology,Zhejiang Hospital,Hangzhou 310013,China)
出处
《心脑血管病防治》
2021年第3期213-217,229,共6页
CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT
基金
浙江省医药卫生重大科技计划(WKJ-ZJ-1809)
浙江省医药卫生科技项目(2018KY190)。
关键词
帕金森病
运动亚型
心率变异
自主神经功能障碍
Parkinson’s disease
Motor subtypes
Heart rate variability
Autonomic dysfunction
