帕金森病运动亚型对动态血压变化的影响

Parkinson's Disease Motor Subtypes and Ambulatory Blood Pressure

目的监测原发性帕金森病（PD）患者的24 h动态血压（ABP）,观察杓型和非杓型血压在不同亚型PD患者中的分布情况,探讨其临床意义。方法研究对象为原发性PD患者40例设为PD组,与之年龄、性别相匹配的健康对照者40名设为对照组。PD组再分为有姿势异常步态障碍型（PIGD）亚组、震颤优势型亚组（震颤亚组）和不确定型亚组。对PD组和对照组行24 h ABP监测,比较PD组和对照组ABP变化,比较杓型和非杓型血压PD患者的特征。结果 PD组夜间平均血压（n MBP）与对照组比较显著增高（P=0.034）;夜间平均动脉血压下降%（MABP%）明显低于对照组（P=0.022）;非杓型血压的发生率明显高于对照组（P=0.039）。杓型血压的PD患者中,女性多于男性（P=0.03）。PIGD亚组的非杓型血压发生率明显高于震颤亚组＋不确定型亚组（P=0.022）。杓型血压PD患者PIGD分值与非杓型血压PD患者比较,差异有显著统计学意义（P=0.003）;MABP%与PIGD分值呈负相关（r=0.622,P=0.000）。MABP%对震颤亚组＋不确定型亚组诊断的敏感度为66.7%,特异度为78.9%,曲线下面积为0.729（95%CI：0.568~0.891）。结论 PIGD患者较非PIGD患者有更明显的血压生物节律调节异常,MABP%是鉴别PIGD和非PIGD较好的指标。

Aim To observe the changes of ambulatory blood pressure（ABP） in patients of Parkinson＇s disease（PD） with different subtypes. Methods 24 h ambulatory blood pressure monitoring were taken in 40 cases of patients with idiopathic PD, compared to 40 healthy controls with matched age and gender. PD group was divided into 2 sub-groups by blood pressure type（dipper or non-dipper）, the characteristic was investigated and compared between these 2 sub-groups. Results The night mean blood pressure（n MBP） was significantly higher in PD group compared to the control group（P=0.034）; the level of averages of mean arterial blood pressure drops at night（MABP %） was significantly lower in PD group than that of the control group（P=0.022）; the incidence of non-dipper type blood pressure in PD group was obviously higher than that in the control group（P=0.039）.Within PD group, blood pressure of dipper type was much more inwomen than in men（P=0.03）; the incidence of non- dipper type blood pressure was obviously much higher in PIGD sub-type in comparison with non-PIGD sub-type（P=0.022）; PIGD score was significantly higher in non-dipper type blood pressure group compared to dipper type blood pressure group（P=0.003）; the percentage of MABP was negatively correlated with PIGD score（r=0.622,P=0.622）. The percentage of MABP had good diagnostic value in distinguishing PIGD sub-type from those of non-PIGD, the sensitivity and specificity was 66.7%, 78.9% respectively; the area under the curve was 0.729（95% CI： 0.568 to 0.891）. Conclusion Patients of PD classified as PIGD sub-type manifested more obvious abnormality in the biological rhythm of blood pressure regulation. The percentage of MABP is a better indicator being used to differentiate PIGD from non-PIGD.