帕金森病患者体位性低血压情况、影响因素及相关模型构建  

Orthostatic hypotension status,influencing factors and related model construction in patients with Parkinson’s disease

作　　者：杨柳[1] 李亚婵 梁潇 白雪[1] 杜成学 刘晓敏[1] 曹媛[1] 陈紫明 YANG Liu;LI Yachan;LIANG Xiao;BAI Xue;DU Chengxue;LIU Xiaomin;CAO Yuan;CHEN Ziming(Department of Neurology,the Affiliated Hospital of Northwest University,Xi'an No.3 Hospital,Xi’an,Shaanxi 710018,China)

机构地区：[1]西北大学附属医院•西安市第三医院神经内科,陕西西安710018

出　　处：《中华神经外科疾病研究杂志》2025年第1期64-68,共5页Chinese Journal of Neurosurgical Disease Research

基　　金：陕西省自然科学研究项目(2022JQ-854)。

摘　　要：目的分析帕金森病(PD)患者体位性低血压(OH)情况、影响因素,并构建发生OH的预测模型。方法回顾性收集2022年1月至2024年3月西北大学附属医院收治的208例PD患者临床资料,根据OH发生情况分为OH组与非OH组,比较两组年龄、病程等基线资料,使用Logistic回归分析筛选PD患者发生OH的独立影响因素,并以上述回归分析结果构建发生OH的预测模型。结果208例PD患者OH发生率为26.44%(55/208)。OH组与非OH组年龄、病程、Hoehn-Yahr分级、UPDRSⅢ评分及RBD、维生素D缺乏、昼夜血压节律比较,差异具有统计学意义(P<0.05)。Logistic回归分析显示,年龄[OR=12.368,95%CI(3.403-44.947),P<0.05]、病程[OR=14.517,95%CI(3.076-68.523),P<0.05]、反勺型昼夜血压节律[OR=3.150,95%CI(1.544-6.426),P<0.05]均为PD患者发生OH的独立危险因素。基于上述3项独立危险因素构建风险列线图预警模型,Bootstrap法重复抽样内部验证显示校准曲线趋近于理想曲线,受试者特征(ROC)曲线显示曲线下面积(AUC)为0.880(95%CI:0.828-0.931),模型预测效能良好。结论高龄、5年及以上病程、昼夜血压节律为反勺型的PD患者更易发生OH,以此构建的预测模型可为PD临床管理提供参考数据。Objective To analyze the orthostatic hypotension(OH)status and its influencing factors in patients with Parkinson’s disease(PD)so as to construct an OH prediction model.Methods The clinical data of 208 PD patients admitted from January 2022 to March 2024 to the Affiliated Hospital of Northwest University were retrospectively analyzed.According to the occurrence of OH,they were divided into OH group and non-OH group.The baseline data such as age and discourse course were compared between the two groups.Logistic regression analysis was used to screen the independent influencing factors of OH in PD patients,and the prediction model of OH was constructed based on the results of the above regression analysis.Results The incidence of OH in 208 PD patients was 26.44%(55/208).Age,disease course,Hoehn-Yahr grading,UPDRSⅢscore and incidence rates of RBD,vitamin D deficiency and circadian blood pressure rhythm revealed statistical differences between OH group and non-OH group(P<0.05).Logistic regression analysis showed that age[OR=12.368,95%CI(3.403-44.947),P<0.05],disease course[OR=14.517,95%CI(3.076-68.523),P<0.05]and reversed dipper circadian blood pressure rhythm[OR=3.150,95%CI(1.544-6.426),P<0.05]were independent risk factors for OH in PD patients.Based on the above three independent risk factors,a risk nomogram warning model was constructed.The internal validation of Bootstrap repeated sampling showed that the calibration curve was close to the ideal curve.Receiver operating characteristic(ROC)curve indicated that the area under the curve(AUC)was 0.880(95%CI:0.828-0.931),and the model had good predictive efficiency.Conclusions PD patients with advanced age,5 years and above course of disease,and reversed dipper circadian blood pressure rhythm are more likely to develop OH.The prediction model constructed in this way can provide reference data for clinical management of PD.

关 键 词：帕金森病 体位性低血压 睡眠 昼夜血压节律 维生素D 

分 类 号：R742.5[医药卫生—神经病学与精神病学]