脑血管反应性和血管危险因素与帕金森病临床进展的相关性研究  

Association of cerebrovascular reactivity and vascular risk factors with clinical progression of Parkinson's disease

作　　者：杨俊 陆敏艳 张锦玲 何庆芳 周红 王圣龙 YIANG Jun;LU Minyan;ZHANG Jinling(Department of Neurology,the Affiliated Jiangsu Shengze Hospital of Nanjing Medical University,Soochow 215228,China)

机构地区：[1]南京医科大学附属江苏盛泽医院神经内科,苏州215228

出　　处：《临床神经病学杂志》2023年第5期351-356,共6页Journal of Clinical Neurology

基　　金：苏州市吴江区“临床医学专家团队”引进项目(WJYJTD201802);苏州市吴江区“科教兴卫”项目(wwk201815);江苏盛泽医院院级科研项目(SYK201805)。

摘　　要：目的 研究不同Hoehn-Yahr(H-Y)分级帕金森病(PD)患者脑血管反应性和血管危险因素的特征,探讨疾病进展的危险因素。方法 抽样选取2019年3月至2022年5月南京医科大学附属江苏盛泽医院收治的特发性PD患者78例,应用改良版H-Y量表评估患者临床严重程度,将其分为早期组(H-Y分级≤2.5期)41例和中晚期组(H-Y分级> 2.5期)37例。另外选取年龄和性别相匹配的健康者44例为对照组。采用TCD检查行屏气试验,记录各组右侧大脑中动脉屏气指数(BHI),调查血管危险因素,比较三组之间的差异,并收集PD患者病程、统一PD评定量表第Ⅲ部分(UPDRS-Ⅲ)评估运动功能、PD自主神经评定量表(SCOPAAUT)评估自主神经功能严重程度及左旋多巴等效日剂量,比较PD两组之间的差异。将单因素分析P <0.1的变量纳入多因素Logistic回归分析,采用逐步LR法筛选变量,确定BHI、血管危险因素与PD患者H-Y分级的相关性。结果 PD早期组与中晚期组既往脑卒中率、同型半胱氨酸水平均高于对照组(均P <0.05);PD中晚期组搏动指数高于对照组(P <0.05);PD早期组与中晚期组BHI均低于对照组,PD中晚期组BHI低于早期组(均P <0.05);PD中晚期组收缩压、舒张压均低于对照组,PD中晚期组收缩压低于早期组(均P <0.05);PD中晚期组病程、左旋多巴等效日剂量、UPDRS-Ⅲ与SCOPA-AUT评分均大于早期组,差异有统计学意义(均P <0.05)。多因素Logistic回归分析显示,BHI降低(OR=0.007,95%CI:0.001~0.611,P=0.030)、UPDRS-Ⅲ与SCOPA-AUT评分升高(OR=1.189,95%CI:1.075~1.316,P=0.001;OR=1.255,95%CI:1.051~1.498,P=0.012),是PD患者发生H-Y> 2.5期的危险因素。结论 脑血管反应性受损、运动及自主神经功能障碍与PD患者疾病进展相关。Objective To investigate the characteristics of cerebrovascular reactivity and vascular risk factors in patients with Parkinson's disease(PD)with different Hoehn-Yahr(H-Y)grades,and to identify risk factors for disease progression.Methods Sampling a total of 78 patients with idiopathic PD who were admitted to Jiangsu Shengze Hospital affiliated to Nanjing Medical University from March 2019 to May 2022 were selected.The clinical severity of the patients was evaluated with the modified H-Y staging.They were divided into the early group(H-Y grade≤2.5)of 41 patients and the middle-advanced group(H-Y grade>2.5)of 37 patients.In addition,44 healthy people matched in age and sex were selected as the control group.The breath holding index(BHI)of the right middle cerebral artery in each group was recorded to investigate vascular risk factors,and differences among the three groups were compared using transcranial Doppler ultrasonography(TCD)examination with breath holding test,and the disease duration of PD patients,Unified Parkinson's Disease Rating Scale(UPDRS-Ⅲ)were collected to assess motor function,Scales for Out-comes in Parkinson's disease-Automatic(SCOPA-AUT)were used to assess the severity of autonomic nervous function and the equivalent daily dose of levodopa were compared between the two groups with PD.Variables with P<0.1 in univariate analysis were included in the multivariate Logistic regression analysis,and the stepwise LR method was used to screen the variables to determine the associations between BHI,vascular risk factors,and H-Y grade in PD patients.Results The rates of previous stroke,homocysteine levels in PD early group and middle-advanced group were higher than those in the control group(all P<0.05).Pulsatility index was higher in the PD middle-advanced group than in the control group(P<0.05).The BHI of PD early group and middle-advanced group were lower than that of the control group,and the BHI of the PD middle-advanced group was lower than that of the early group(all P<0.05).Systolic and diast

关 键 词：帕金森病 H-Y分级 经颅多普勒超声 屏气指数 脑血管反应性 危险因素 

分 类 号：R742.5[医药卫生—神经病学与精神病学]