经颅多普勒超声结合卧立位试验检查帕金森病患者脑自主调节功能  

Transcranial doppler ultrasound combined with supine-to-standing test to examine cerebral autoregulation in Parkinson’s disease

作　　者：陈玉辉[1] 李淑华[1] 王音[1] 徐蕾[1] 李伟[1] 刘洁[1] 龚涛[1] CHEN Yuhui;LI Shuhua;WANG Yin;XU Lei;LI Wei;LIU Jie;GONG Tao(Department of Neurology,Beijing Hospital,National Center of Gerontology,Beijing 100730,China)

机构地区：[1]北京医院神经内科国家老年医学中心

出　　处：《中国神经免疫学和神经病学杂志》2019年第3期179-183,188,共6页Chinese Journal of Neuroimmunology and Neurology

基　　金：北京医院院级课题(BJ-2015-134)

摘　　要：目的采用经颅多普勒超声(TCD)结合卧立位试验检查帕金森病(PD)患者脑自主调节功能是否存在障碍。方法收集2016年1月至2017年12月在北京医院就诊的原发性PD患者24例,另选取同期健康查体者24名作为对照组。对受试者进行卧位-立位-再卧位试验,测量受试者卧位、站立即刻、站立末双侧肱动脉收缩压(SBP)和舒张压(DBP)。采用TCD监测记录受试者大脑中动脉(MCA)峰值血流速度(PFV)、舒张末期血流速度(DFV)、平均血流速度(MFV)以及搏动指数(PI)、阻力指数(RI)的变化情况。结果与对照组比较,站立即刻PD患者血压下降幅度更明显[SBP:(-11.71±14.83)mmHg比(1.25±11.07)mmHg,DBP:(-3.30±9.88)mmHg比(5.08±5.61)mmHg;均P< 0.05]。站立即刻PD组PI和RI增加幅度较对照组低(PI:0.17±0.16比0.33±0.23,RI:0.06±0.05比0.11±0.07;均P< 0.05)。站立末时,PD组血压下降幅度仍较对照组明显(P< 0.05)。PD组和对照组间PFV、DFV、MFV变化无统计学差异(均P> 0.05)。结论 PD患者站立即刻PI、RI变化幅度较正常对照者低,提示PD患者存在脑自主调节功能调节障碍。Objective To investigate whether there is cerebral autoregulation dysfunction in Parkinson's disease(PD) by transcranial dopplcr ultrasound(TCD) combined with supine-to-standing test.Methods 24 PD patients and 24 normal controls were recruited prospectively,blood pressure was detected,middle cerebral artery(MCA) blood flow velocity,including peak blood flow velocity(PFV),diastolic velocity(DFV),mean blood flow velocity(MFV),pulsatility index(PI),resistance index(RI) were monitored during supinc-standingrcsupine positions.We then analyzed these values and their changes among PD patients and normal controls.Results Compared with the control group,the blood pressure of PD patients significantly decreased immediately after standing [SBP:(-11.71±14.83) mmHg vs.(1.25±11.07) mmHg,DBP:(-3.30 ± 9.88) mmHg vs.(5.08±5.61) mmHg;P0.05].The increase of PI and RI immediately after standing in PD group was lower than that in the control group(PI:0.17±0.16 vs.0.33±0.23,RI:0.06±0.05 vs.0.11±0.07;P0.05).At the end of standing,the blood pressure of the PD group was still significantly lower than that of the control group(P 0.05).However,the changes of PFV,DFV,MFV didn't show statistically significant differences between the two groups(P0.05).Conclusions The changes of PI and RI immediately after standing were less significant in PD patients than those in controls,suggesting that PD patients may have cerebral autorcgulation dysfunction.

关 键 词：帕金森病 超声检查 多普勒 经颅 低血压 直立性 血流速度 脑自主调节功能 

分 类 号：R742.5[医药卫生—神经病学与精神病学]