摘要
目的探讨帕金森病(PD)患者认知障碍与直立位低血压(OH)的关系。方法选取临床确诊的原发性PD患者,测量卧位、立位血压,以卧位转为立位3min内收缩压下降≥20mmHg和(或)舒张压下降≥10mmHg为OH诊断标准,应用简易精神状态量表(MMSE)评估认知功能,以MMSE分值低于分界值(文盲≤17分,小学文化程度≤20分,初中及以上文化程度≤24分)作为认知障碍的评定标准,分析OH与认知障碍的关系。结果连续入组2017-09-2018-05西安交通大学第一附属医院帕金森病门诊就诊的PD患者169例,其中男100例(59.17%),年龄41~84(64.27±9.63)岁,初中及以上文化程度136例(80.5%)。符合OH标准48例(28.4%),MMSE得分低于分界值40例(23.7%),OH组MMSE得分低于非OH组(23.04±4.58vs26.31±2.96,P<0.05),OH组认知障碍发生率高于非OH组(47.91%vs14.05%,P<0.05)。Spearman秩相关分析显示,MMSE得分与受教育年限呈正相关,与年龄、病程、H-Y分级、卧位收缩压、卧立位收缩压下降值及卧立位舒张压下降值均呈负相关。非条件Logistic多因素回归分析显示,与认知障碍相关的因素有年龄(OR=1.761,95%CI=1.078~2.877,P<0.05)、H-Y分级(OR=1.962,95%CI=1.055~3.651,P<0.05)、受教育年限(OR=0.389,95%CI=0.188~0.804,P<0.05)、OH(OR=5.662,95%CI=2.302~13.927,P<0.05)。结论OH与PD认知障碍密切相关,加强OH防治,可能对于防治PD认知障碍具有重要意义。
Objective To investigatethe relationships between cognitive impairment and orthostatic hypotension(OH)in pa⁃tients with Parkinson’s disease(PD).Methods PD patients from Department of Neurology,the First Affiliated Hospital of Xi’an Jiaotong University were measured supine blood pressure and orthostatic blood pressure,and orthostatic hypotension(OH)was de⁃fined as the systolic blood pressure decreased≥20 mmHg and/or diastolic blood pressure decreased≥10 mmHg within 3 minutes af⁃ter translocation from the supine to orthostatic position.Mini-mental state scale(MMSE)was usedto assess cognitive function,and MMSE score below the cut-off value(illiteracy≤17,primary education≤20,junior high education≤24)was defined as the cogni⁃tive impairment.Logistic multivariate regression was used to analyze the relationship between OH and cognitive impairment.Results A total of 169 PD patients from Sept.2017 to May 2018 were enrolled,among which 100 were males(59.17%),aged 41-84(64.27±9.63),and 136(80.5%)had junior high school or above education.There were 48 cases(28.4%)met the criterion of OH and 40 cases(23.7%)met the definition of cognitive impairment.MMSE score was lower in the OH group than that in the non-OH group(23.04±4.58 vs 26.31±2.96,P<0.05),and the prevalence of cognitive impairment was higher in the OH group than that in the non-OH group(47.91%vs 14.05%,P<0.05).Spearman rank correlation analysis showed that MMSE score correlated with years of ed⁃ucation positively,and negatively correlated with age,disease course,Hoehn and Yahr scale,supine systolic blood pressure and OH.In the multivariate Logistic regression analysis,the factors associated with cognitive impairment were age(OR=1.761,95%CI=1.078-2.877,P<0.05),Hoehn and Yahr scale(OR=1.962,95%CI=1.055-3.651,P<0.05),years of education(OR=0.389,95%CI=0.188-0.804,P<0.05),OH(OR=5.662,95%CI=2.302-13.927,P<0.05).Conclusion OH is associated with cognitive impairment in PD patients.Treatment of OH might be important for the prevention of PD cognitive
作者
弥婉军
邓永宁
张萌
曹红梅
屈秋民
MI Wanjun;DENG Yongning;ZHANG Meng;CAO Hongmei;QU Qiumin(The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Weinan Central Hospital,Weinan 714000,China)
出处
《中国实用神经疾病杂志》
2021年第10期829-834,共6页
Chinese Journal of Practical Nervous Diseases
基金
陕西省重点研发计划重点项目(编号:2018ZDXM-SF-052)。
关键词
帕金森病
认知功能减退
直立位低血压
自主神经
运动症状
Parkinson’s disease
Cognitive impairment
Orthostatic hypotension
Autonomic nerve
Motor symptoms
