帕金森病患者24小时动态血压变化及其影响因素的临床研究

The Patterns of Twenty-four Hour Non-invasive Ambulatory Blood Pressure and the Related Factors in Parkinson's Disease

目的研究帕金森病(PD)患者动态血压变化特点及其相关的影响因素。方法采用无创性携带式动态血压监测仪行24 h动态血压监测,评估81例PD患者(PD组)和59名正常对照者(对照组)的动态血压变化节律,同时进行PD非运动症状问卷调查,探讨病理性血压节律的相关影响因素。结果①PD组患者血压节律倾向于非杓型血压;卧位血压升高的发生率较正常对照组高(P=0.001)。②PD组24 h平均血压、24 h平均收缩压、夜间平均血压、夜间平均收缩压、夜间平均舒张压均较对照组升高(P<0.05);夜间平均动脉血压下降水平[MABP(%)]较对照组明显降低(P<0.05)。③PD患者夜间血压变异系数(CV)与病程(P=0.019)、H-Y分级(P=0.047)、UPDRS评分(P=0.031)、心血管症状相关(P=0.016)、睡眠/疲劳(P=0.049)因素呈正相关。结论 PD患者血压节律偏向于非杓型血压,并广泛存在夜间血压升高现象,病理性血压节律可能是自主神经功能受损的潜在指标。

ABSTRACT Aim To investigate the ambulatory blood pressure profile in patients with Parkinson＇s disease（PD） and its influencing factors. Methods Eighty-one PD patients and fifty-nine normal controls were studied with 24 hours ambulatory blood pressure monitoring, the dynamic rhythm of blood pressure changes were evaluated, and the non-movement symptoms in PD patients were investigated. The related factors affecting pathologic rhythm of blood pressure were explored. Results ① 24-hour blood pressure monitoring showed a high prevalence of non-dipping in PD patients. Compared with the control, supine hypertension was more common in PD （P=-0.001）. ②Among all the measured parameters, a statistically significant difference was observed between PD and the controls for 24 h mean blood pressure（24 h MBP）, 24 h systolic blood pressure（24 h SBP）, night mean blood pressure（nMBP）, night mean blood pressure（nSBP）, night diastolic blood pressure（nDBP）（P〈0.05）, and percentage nocturnal dipping of averages of the mean arterial blood pressure [（MABP）%] （P〈0.05）. ③Nocturnal blood pressure variation coefficient （CV） in PD patients was positive correlation to disease duration （P=0.019）, Hohen- Yahr staging （P=0.047）, UPDRS rating （P=0.031）, the cardiovascular system related （P=0.016）, sleep/ fatigue （P=0.049）. Conclusion PD patients had a high prevalence of non-dipping and supine hypertension, 24-hour blood pressure monitoring may be useful to identify non-dipping as a marker of autonomic dysfunction in patients with PD.