帕金森病患者动态血压对认知功能的影响

Effects of 24-hour ambulatory blood pressure on cognitive function in patients with Parkinson's disease

目的帕金森病(PD)患者多伴有动态血压(ABP)异常和认知功能障碍,PD认知功能减退的机制不明确,本研究旨在探讨PD患者ABP的变化对其认知功能改变的影响。方法选取60例简易精神状态检查量表(Minimum Mental State Examination,MMSE)评分排除严重认知功能障碍的PD患者和40例年龄、性别相匹配的健康人作为对照,分别予以24小时ABP监测和蒙特利尔认知功能评估(MoCA)评分,比较两组ABP的变化,并评价ABP的变化值对认知功能的影响程度。结果 PD组非杓型血压的发生率明显高于对照组(P=0.028);PD组夜间平均血压(nMBP)与对照组比较显著增高(P=0.049);PD组夜间平均动脉血压下降水平(MABP%)明显低于对照组(P=0.022);PD组MoCA评分明显低于对照组(P=0.024);PD组MABP%、帕金森病评定量表第三部分(UPDRS)评分、年龄和教育年限对MoCA评分有着显著的影响(P=0.04、0.012、0.015、0.020),对照组教育年限和年龄对MoCA评分有显著影响(P=0.010和0.035)。结论 PD患者而非正常人的MABP%是其认知功能下降的独立危险因素。

Objective Patients with Parkinson's disease(PD)are commonly accompanied by abnormal dynamic blood pressure(ABP)and cognitive impairment and the exact mechanism of the cognitive impairment is unclear.We aim to investigate the relationship between ambulatory blood pressure(ABP)and cognitive function in PD patients.Methods 24 h ABP monitoring were taken in 60 cases of patients with idiopathic PD,compared to 40 healthy controls with matched age and gender.24 h ABP monitoring and MoCA scores were performed in the two groups.The change of the two groups of ABP were compared and the influence of ABP change in cognitive function was evaluated.Results The incidence of non dipping blood pressure in PD group was significantly higher than that in control group(P=0.028).Night mean blood pressure(nMBP)of PD group increased significantly compared with control group(P=0.049).The decrease of mean arterial blood pressure in PD group at night(MABP%)was significantly lower than that in the control group(P=0.022).MoCA score of PD group was significantly lower than that of control group(P=0.024).MABP%,UPDRS,age and education years in PD group had significant influence on MoCA score(P=0.04,0.012,0.015,0.020),while education years and age in control group had significant influence on MoCA score(P=0.010 and 0.035,respectively).Conclusion MABP%is an independent risk factor for PD patient’s cognitive decline rather than normal people.