帕金森病患者伴发体位性低血压的特点及其对认知功能的影响  

Parkinson's disease combined with orthostatic hypotension:characteristics and its effects on cognitive function

作　　者：李丽霞[1] 连腾宏 郭鹏[2] 丁杜宇 李丹凝 张伟娇 关惠盈 高俊华[2] 张巍[3,4,5,6] Li Lixia;Lian Tenghong;Guo Peng;Ding Duyu;Li Danning;Zhang Weijiao;Guan Huiying;Gao Junhua;Zhang Wei(Department of Internal Medicine,Beijing Tianan Hospital.Capital Medical University,Beijing 100070,China;Center for Cognitive Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurology,Center for Cognitive Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;China National Clinical Research Center for Neurological Diseases,Beijing 100070,China;Center of Parkinson's Disease,Beijing Institute for Brain Disorders,Beijing 100053.China;Key Laboratory for Neurodegeneratire Disorders of the Mimistry of Education,Capial Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京天坛医院综合内科,100070 [2]首都医科大学附属北京天坛医院神经病学中心,100070 [3]首都医科大学附属北京天坛医院神经病学中心认知障碍性疾病科,100070 [4]国家神经系统疾病临床医学研究中心,100070 [5]北京脑重大疾病研究院帕金森病研究所,100053 [6]帕金森病研究北京重点实验室,100053

出　　处：《中华老年医学杂志》2020年第9期1001-1005,共5页Chinese Journal of Geriatrics

基　　金：国家重点研发计划重点专项(2016YFC1306000.2016YFC1306300);国家重点研发计划-欧盟地平线2020计划合作项目(2017YFE0118800-779238);国家自然科学基金面上项目(81970992.81571229.81071015.30770745).

摘　　要：目的探讨帕金森病(PD)患者伴发体位性低血压(OH)的特点及其对认知功能的影响。方法连续收集北京天坛医院210例PD患者,记录人口学资料及临床特征。测量患者的立卧位血压,按照是否伴发OH分为PD伴发OH(PD-OH)组和PD不伴发OH(PD-NOH)组。采用简易精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评价患者的认知功能。结果在210例PD患者中,68例伴发OH,OH的发生率为32.4%。PD-OH组与PD-NOH组相比,年龄更大[(69.7±8.9)岁比(62.1±11.3)岁],病程更长[5.0(3.0~8.0)年比4.0(2.0~6.0)年],合并糖尿病的患者更多(30.9%比17.4%),空腹血糖更高[(5.3±1.1)mmol/L比(5.0±1.0)mmol/L],糖化血红蛋白水平更高[(6.1±0.9)%比(5.7±0.7)%],H-Y分期更高[2.5(2.0~3.0)期比2.0(1.5~2.5)期](P<0.05)。PD-OH组患者MMSE量表总分及MoCA量表总分均较PD-NOH组明显下降[(25.1±4.9)分比(26.8±4.0)分;(19.4±5.4)分比(21.4±5.3)分](P<0.05)。两组患者MMSE量表各分项评分比较,PD-OH组患者注意力和计算力[(3.7±1.7)分比(4.2±1.3)分]、延迟回忆[(2.1±1.0)分比(2.5±0.8)分]及图形复制评分[(0.6±0.5)分比(0.7±0.5)分]均明显下降(P<0.05)。MoCA量表各分项评分比较,PD-OH组患者视空间和执行功能[(2.4±1.6)分比(2.9±1.7)分]、延迟回忆力评分[(1.3±1.4)分比(2.3±1.6)分]较PD-NOH组明显下降(P<0.05)。Logistic回归分析显示,年龄(OR=1.061,95%CI:1.022~1.102,P=0.002)和MoCA量表的延迟回忆评分(OR=0.690,95%CI:0.498~0.955,P=0.025)是PD-OH的独立相关因素。结论PD-OH患者年龄更大,病程更长,病情更重,合并糖尿病更多、程度更重,高龄是PD-OH的独立相关因素。PD-OH患者认知功能明显受损,延迟回忆下降是PD-OH的独立相关因素。Objective To investigate the characteristics of Parkinson's disease(PD)combined with orthostatic hypotension(OH)and the impact of the condition on cognitive function.Methods A total ol 210 PD patients admitted to Beijing Tiantan Hospital were consecutively enrolled.Demographic data and clinical characteristics were recorded.Patients were divided into the PD with OH(PD-OH)group and the PD without OH(PD-NOH)group based on blood pressure values measured in both the supine and upright positions.Cognitive function of PD patients was evaluated using the Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)scales.Results Of 210 PD patients.68(32.4%)had OH.Patients in the PD OH group had a higher mean age(69.7±8.9 yearsus.62.1±11.3 years),longer disease duration[5.0(3.0-8.0)yearsus.4.0(2.0-6.0)years],a higher incidence of diabetes(30.9%us.17.4%),higher levels of fasting blood glucose(5.3±1.1 mmol/Lus.5.0±1.0 mmol/L)and glycated hemoglobin Alc(6.1±0.9%us.5.7±0.7%),and more advanced Hoehn Yahr staging[stage 2.5(2.0-3.0)vs.stage 2.0(1.5-2.5)]than the PD NOH group(P<0.05).The total scores of the MMSE and MoCA scales were lower in the PD-OH group than in the PD-NOH group(25.1±4.9 scores Us.26.8±4.0 scores,19.4±5.4 scores vs.21.4±5.3 scores,P<0.05).A comparison of each cognitive domain of the MMSE scale between the two groups revealed that the scores of attention and calculation(3.7±1.7 scores us.4.2±1.3 scores),delayed recall(2.1±1.0 scores Us.2.5±0.8 scores)and visuospatial ability(0.6±0.5 scores vs.0.7±0.5 scores)were lower in the PD-OH group than in the PD-NOH group(P<0.05).A comparison of each cognitive domain of the MoCA scale between the two groups displayed that the scores of visuospatial and executive function(2.4±1.6 scores vs.2.9±1.7 scores)and delayed recall(1.3±1.4 scores us.2.3±1.6 scores)were lower in the PDOH group than in the PD NOH group(P<0.05).Logistic regression analysis showed that age(OR=1.061.95%CI:1.022-1.102,P=0.002)and score of delayed recall of the MoCA scale

关 键 词：帕金森病 体位性低血压 认知功能 

分 类 号：R742.5[医药卫生—神经病学与精神病学]