| 柳竹
，苏东宁
，刘亘梁
，王雪梅
，王展
，马惠姿
，冯涛,,.帕金森病合并体位性低血压及卧位高血压的临床特征分析[J].神经损伤功能重建,2022,17(8):439-443 |
| 帕金森病合并体位性低血压及卧位高血压的临床特征分析 |
| Clinical Features of Orthostatic Hypotension and Supine Hypertension in Patients with Parkin⁃son’s Disease |
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| DOI： |
| 中文关键词: 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 |
| 英文关键词: Parkinson’s disease orthostatic hypotension supine hypertension autonomic nervous system lying to standing blood pressure test |
| 基金项目:国家自然基金青年
科学基金（No. 819
01833）；
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. Z1811000017
18059） |
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| 中文摘要: |
| 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。 |
| 英文摘要: |
| 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 of
198 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 2
groups, 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 was
62.1%. 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 of cognitive impairment between the 2 groups (P>0.05). Conclusion: The incidence of combined OH
and SH in PD patients was high. We did not find evidence that PD-OH with SH increases risk of cardiovascular
and cerebrovascular disease; on the contrary, SH played a protective role against clinically significant OH. PD patients with combined OH
and SH should beware the risk of falls and dementia. |
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