摘要
目的:探讨帕金森病(PD)同时伴有体位性低血压(OH)及卧位高血压(SH)患者的血流动力学、心脑血管发病率及高危因素的特征,以及对运动症状和非运动症状的影响。方法:入组PD合并OH患者198例,伴有SH 123例(SH组),不伴有SH 75例(无SH组)。记录所有入组患者临床信息、实验室检查结果,进行各项运动及非运动症状临床量表的评估。进行卧立位试验及急性左旋多巴冲击试验,记录血压变化。比较2组间的基本临床信息,心脑血管疾病及风险因素,冲击试验服药前后血压的变化及量表评分。结果:伴有OH的PD患者中SH的发生率为62.1%。2组间年龄、性别、病程、左旋多巴等效剂量无明显差异。与无SH组相比,SH组同型半胱氨酸略高(P<0.05),余各项心脑血管疾病高危因素差异无统计学意义(P>0.05)。SH组MDS-UPDRS III运动功能总分及姿势步态异常得分更高(P<0.05);SH组在服药前卧立位试验及急性左旋多巴冲击试验后收缩压下降最大差值较高(P<0.05),但出现临床显著OH的发生率较低(P<0.05);无SH的PD-OH患者出现临床显著OH的风险是有SH的PD-OH患者的近3倍(OR=2.991,P=0.002)。认知评估中,SH组的MMSE量表回忆能力子项、定向力子项、MoCA量表总分、视空间与执行功能子项、定向力子项的评分均低于无SH组(均P<0.05),但2组间认知障碍的发生率差异无统计学意义(P>0.05)。结论:PD患者中合并OH及SH的发生率高,尚未发现PD-OH伴有SH增加心脑血管疾病风险,且SH对显著OH起到一定保护作用。PD-OH伴SH患者需注意跌倒和痴呆风险。
Objective: To investigate the characteristics of hemodynamics and cardiovascular and cerebrovascular disease and its high-risk factors in patients with Parkinson’s disease(PD) with orthostatic hypotension(OH)and supine hypertension(SH) and examine its effects on motor and non-motor symptoms. Methods: A total of198 PD-OH patients were enrolled. Of these, 123 patients experienced SH(SH group) and 75 did not(non-SH group). Patients’ clinical information, laboratory results, and comprehensive set of clinical features including both motor and non-motor symptoms were recorded. The lying to standing blood pressure(BP) test and acute levodopa challenge test were administered. We compared demographics and clinical features between the 2groups, including cardiovascular and cerebrovascular disease and its high-risk factors as well as pre-and post-drug blood pressure and test scores. Results: The incidence of coexisting SH and OH in PD patients was62.1%. There were no significant differences in age, sex, disease course, or levodopa equivalent dose between the 2 groups. Homocysteine was slightly higher in the SH group compared with the non-SH group(P<0.05), and there were no significant differences in the remaining high-risk factors for cardiovascular and cerebrovascular disease(P>0.05). The SH group showed a higher motor function score and higher postural instability and gait difficulty on the MDS-UPDRS III(P<0.05). The SH group presented a greater decrease in systolic BP after the pre-drug lying to standing BP test and acute levodopa challenge test(P<0.05) but a lower incidence of clinically significant OH(P<0.05). The risk of clinically significant OH was 3 times higher in the non-SH group than in the SH group(OR=2.991, P=0.002). In cognitive assessments, the SH group had a lower score in memory recall and orientation on the MMSE and a lower total score, visuospatial and executive function score, and orientation score on the MoCA compared to the non-SH group(P<0.05). There was no significant difference in the incidence
作者
柳竹
苏东宁
刘亘梁
王雪梅
王展
马惠姿
冯涛
LIU Zhu;SU Dong-ning;LIU Gen-liang;WANG Xue-mei;WANG Zhan;MA Hui-zi;FENG Tao(Center for Neurodegenerative Disease,Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;China National Clinical Research Center for Neurological Disease,Beijing 100070,China;Parkinson’s Disease Center,Beijing Institute for Brain Disorder,Capital Medical University,Beijing 100070,China)
出处
《神经损伤与功能重建》
2022年第8期439-443,466,共6页
Neural Injury and Functional Reconstruction
基金
国家自然基金青年科学基金(No.81901833)
北京市科学技术委员会首都临床特色应用研究青年项目(No.Z181100001718059)。
关键词
帕金森病
体位性低血压
卧位高血压
自主神经功能
卧立位试验
Parkinson’s disease
orthostatic hypotension
supine hypertension
autonomic nervous system
lying to standing blood pres-sure test
