帕金森病患者血压昼夜节律紊乱临床特点及对直立性低血压影响的初步分析  

A pilot study on the clinical characteristics of blood pressure circadian rhythm disorder and its impact on orthostatic hypotension in Parkinson′s disease

作　　者：肖仁清 宋璐[1] 赵嘉豪 朱晓波 干静[1] 吴娜[1] 万赢[1] 刘振国[1] Xiao Renqing;Song Lu;Zhao Jiahao;Zhu Xiaobo;Gan Jing;Wu Na;Wan Ying;Liu Zhenguo(Department of Neurology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院神经内科,上海200092

出　　处：《中华神经科杂志》2023年第5期494-503,共10页Chinese Journal of Neurology

基　　金：国家重点研发计划“重大慢性非传染性疾病防控研究”重点专项(2017YFC1310300);国家自然科学基金(81974173,82171242);上海市卫生健康委员会先进适宜技术推广项目(2019SY024);上海医学引导类科技支撑项目(19401932100);上海市中西医临床协作试点项目(ZXYXZ-201907);上海市综合医院中西医结合专项(ZHYY-ZXYJHZX-202021);上海市浦江人才计划(2021PJD046,2020PJD032)。

摘　　要：目的初步观察帕金森病患者血压昼夜节律紊乱的临床特点及对直立性低血压(OH)的影响。方法连续采集2019年8月至2021年10月在上海交通大学医学院附属新华医院就诊的165例帕金森病患者病史,完成运动和非运动症状评分,并采集患者24 h动态血压和卧-立位血压数据,完成OH问卷调查。观察血压昼夜节律紊乱各类型(觉醒期低血压、反杓型血压、夜间高血压)的发生率,分别采用t检验、卡方检验、U检验和线性回归分析方法观察3种血压昼夜节律紊乱类型的临床特点及影响因素,并采用Logistic回归分析探究血压昼夜节律紊乱各类型与OH和症状性OH(SOH)的关系。结果在165例帕金森病患者中,反杓型血压发生率为39.39%(65/165),夜间高血压发生率为43.64%(72/165),觉醒期低血压发生率为31.52%(52/165)。与无反杓型血压患者相比,伴反杓型血压患者年龄较大[分别为(71.72±7.81)岁、(65.29±9.68)岁,t=-4.491,P<0.001]、起病年龄较晚[分别为(66.67±9.10)岁、(62.16±10.66)岁,t=-2.809,P=0.006]、病程(月)更长[分别为36.00(20.50,95.50)、24.00(12.00,41.75),Z=-3.393,P<0.001]、每日左旋多巴剂量(LD)[分别为(426.15±267.38)mg/d、(284.00±235.58)mg/d,t=-3.590,P<0.001]和每日左旋多巴等效剂量(LED)[分别为(514.80±360.03)mg/d、(341.44±284.57)mg/d,t=-3.440,P=0.001)更大、统一帕金森病评定量表(UPDRS)-Ⅱ评分[分别为(12.92±6.38)分、(9.54±5.59)分,t=-3.434,P=0.001]和UPDRS-Ⅲ评分[分别为(28.34±11.60)分、(21.41±12.18)分,t=-3.508,P=0.001]更高、幻觉比例[分别为18.46%(12/65)、7.00%(7/100),χ^(2)=5.079,P=0.024]更高;与无觉醒期低血压患者相比,伴发觉醒期低血压患者年龄较大[分别为(70.83±7.09)岁、(66.44±10.16)岁,t=-2.811,P=0.006];与无夜间高血压患者相比,伴发夜间高血压患者病程(月)更长[分别为39.50(15.00,96.00)、24.00(12.00,36.00),Z=-2.944,P=0.003]、LD[分别为(398.61±251.19)mg/d、(294.62±254.25)mg/d,t=-2.619,Objective To investigate the clinical characteristics of circadian rhythm disorder of blood pressure and its impact on orthostatic hypotension(OH)in Parkinson′s disease(PD).Methods A total of 165 PD patients from Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from August 2019 to October 2021 were consecutively enrolled.Medical history and scores of motor and non-motor symptoms of patients were collected.Twenty-four-hour ambulatory blood pressure and OH data were collected,and the OH questionnaire was completed.The incidence of each type of circadian rhythm disorder of blood pressure was investigated.The t test,chi-square test and Mann-Whitney U test were used to determine between-group differences of circadian rhythm disorder of blood pressure.The linear trends in clinical characteristics were tested by linear regression analysis.Logistic regression analysis was used to analyze the relationship between different circadian rhythm disorders of blood pressure and OH as well as symptomatic OH(SOH).Results In 165 PD patients,the incidence of reverse dipping pattern was 39.39%(65/165),nocturnal hypertension was 43.64%(72/165),and awakening hypotension was 31.52%(52/165).Compared with patients without reverse dipping pattern,patients with reverse dipping pattern were older[(71.72±7.81)years vs(65.29±9.68)years,t=-4.491,P<0.001],had later onset age[(66.67±9.10)years vs(62.16±10.66)years,t=-2.809,P=0.006],longer duration[36.00(20.50,95.50)months vs 24.00(12.00,41.75)months,Z=-3.393,P<0.001],higher dose of levodopa(LD)[(426.15±267.38)mg/d vs(284.00±235.58)mg/d,t=-3.590,P<0.001],higher levodopa equivalent dose(LED)[(514.80±360.03)mg/d vs(341.44±284.57)mg/d,t=-3.440,P=0.001],higher Unified Parkinson′s Disease Rating Scale(UPDRS)-Ⅱscores(12.92±6.38 vs 9.54±5.59,t=-3.434,P=0.001),higher UPDRS-Ⅲscores(28.34±11.60 vs 21.41±12.18,t=-3.508,P=0.001)and higher percentages of hallucinations[18.46%(12/65)vs 7.00%(7/100),χ^(2)=5.079,P=0.024].Compared with patients without awakening h

关 键 词：帕金森病 低血压 直立性 血压昼夜节律紊乱 临床特征 相关性 

分 类 号：R742.5[医药卫生—神经病学与精神病学]