帕金森病抑郁与自主神经症状网络分析  

A network analysis of depression and autonomic symptoms in Parkinson disease

作　　者：刘彤 唐玮婷 熊亦璇 游咏 LIU Tong;TANG Weiting;XIONG Yixuan(Department of Neurology,The Second Affiliated Hospital of Hainan Medical University,Haikou 570100,China)

机构地区：[1]海南医学院附属第二医院神经内科,海南海口570100

出　　处：《中风与神经疾病杂志》2025年第2期115-120,共6页Journal of Apoplexy and Nervous Diseases

基　　金：国家自然科学基金资助项目(82360230);海南省重点研发计划项目(ZDYF2022SHFZ108)。

摘　　要：目的探究帕金森病(PD)抑郁与自主神经功能相关性,为PD抑郁的临床治疗提供依据。方法分析2022年7月—2023年7月就诊于海南医学院第二附属医院神经内科的168例PD患者临床及神经循环数据,通过贝克抑郁量表将患者分为PD伴抑郁(dPD)组(57例)和PD非抑郁(nPD)组(111例),收集患者的一般临床信息,并进行TCD监测下的卧立位实验,分别于1min,3min,5min记录患者卧位及立位收缩压(SBP)、舒张压(DBP)、心率(HR),及大脑中动脉的平均脑血流速度(Vm)、搏动指数(PI)、阻力指数(RI),构建PD抑郁症状网络。结果抑郁在PD非运动症状网络中心性最高,可预测性最强,与睡眠/疲劳、情绪/认知强相关(强度中心性相关稳定系数,CS strength=0.440)。相较于nPD组,dPD组卧位HR、ΔHR、立位Vm、ΔVm%更小,ΔDBP更大,更易发生头晕伴直立性低血压和直立性脑低灌注(P<0.05)。抑郁与ΔSBP、ΔDBP、卧位Vm、立位RI正相关,与ΔHR、卧位DBP、卧位HR、ΔPI呈负相关(CS strength=0.375,CS strength=0.222)。结论心血管和脑自主神经功能受损可能参与PD发生抑郁的机制,抑郁的干预有助于改善PD的整体非运动症状,睡眠、疲劳、认知是改善PD抑郁的有效靶点。Objective To investigate the association between depression and autonomic nervous function in Parkinson disease(PD),and to provide a basis for clinical treatment.Methods Clinical and neurocirculation data were collected from 168 PD patients who attended Department of Neurology,The Second Affiliated Hospital of Hainan Medical College,from July 2022 to July 2023,and according to the score of Beck Depression Inventory,the patients were divided into depression in PD(dPD)group with 57 patients and non-dPD(nPD)group with 111 patients.General clinical data were collected from all patients.The supine-to-standing TCD test was performed for all patients to record systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),and the mean velocity(Vm),pulsatility index(PI),and resistance index(RI)of the middle cerebral artery(MCA)at 1,3,and 5 minutes in both the supine and standing positions.A network was constructed for depression symptoms in PD.Results In the network of non-motor symptoms in PD,depression showed the highest centrality and the strongest predictability and was strongly correlated with sleep/fatigue and mood/cognition,with a strength centrality stability coefficient(CS strength)of 0.440.Compared with the nPD group,the dPD group had significantly lower supine HR,ΔHR,Vm in the standing position,andΔVm%,a significantly greaterΔDBP,and a significantly higher proportion of patients with dizziness with orthostatic hypotension or orthostatic cerebral hypoperfusion(P<0.05).Depression was positively correlated withΔSBP,ΔDBP,Vm in the supine position,and RI in the standing position,and it was negatively correlated withΔHR,DBP in the supine position,HR in the supine position,andΔPI(CS strength=0.375 and 0.222).Conclusion Impairment of cardiovascular and cerebral autonomic nervous function might be involved in the pathogenesis of depression in PD,and intervention of depression can help improve the overall nonmotor symptoms of PD,with sleep,fatigue,and cognition as the effective targets for improving de

关 键 词：帕金森病 抑郁 自主神经功能 网络分析 

分 类 号：R742.5[医药卫生—神经病学与精神病学]