TCD联合卧立位试验观察帕金森病患者神经循环异常的临床特点

An observational study on Characteristics of neurocirculation abnormalities in patients with Parkinson's disease by TCD combined with orthostatic test

目的通过分析帕金森病(Parkinson’sdisease,PD)患者经颅多普勒(transcranial doppler,TCD)联合卧立位试验检查结果,探讨PD患者神经循环异常的临床特点。方法纳入2017年4月至2019年2月在南华大学附属第一医院及海南医学院第二附属医院神经内科门诊就诊及住院的PD患者。收集一般临床资料,采用统一帕金森病评定量表第三部分(Unified Parkinson’s Disease Rating Scale,UPDRS-Ⅲ)评估运动功能,H-Y分期(Hoehn&Yahr staging)评估疾病严重程度,非运动症状问卷(non-motor symptoms questionnaire,NMSQ)评估非运动症状,帕金森病自主神经功能障碍量表(Scales for Out-comes in Parkinson’s disease-Autonomic,SCOPA-AUT)评估自主神经功能严重程度。同时完善卧立位TCD实验,记录患者卧位及立位1 min、3 min和5 min时血压、心率及脑血流动力学变化情况。依据卧立位试验结果,包括卧立位血压、心率及脑血流动力学变化特点,将PD患者分为5组:直立性脑低灌注(orthostatic hypoperfusion,OHP)组、直立性低血压不伴直立性脑低灌注(orthostatic hypotension-compensated,OH-C)组、直立性低血压伴直立性脑低灌注(OH-uncompensated,OH-U)、直立性高血压(orthostatic hypertension,OHT)组和正常反应组,对比各组患者临床特征。结果共纳入87例PD患者,其中男65例(74.7%)、女22例(25.3%)。其中卧立位试验异常患者35例(40.2%),其中OH-C组9例(10.3%),OH-U组13例(14.9%),OHT组3例(3.4%),OHP组10例(11.5%)。与卧立位试验正常患者相比,卧立位试验异常PD患者UPDRS-Ⅲ、SCOPA-AUT及NMSQ评分更高(均P<0.05)。OH-U组及OHP组患者较卧立位试验正常患者直立性头晕比例更高(均P<0.05)。结论PD合并神经循环障碍较为常见,主要表现为血压调节和脑血管自主调节异常,这类患者运动功能、自主神经功能及情绪、认知损害可能较为严重。

Objective To explore the clinical characteristics of neurocirculatory abnormalities in patients with Parkinson's disease(PD)by analyzing the results of TCD combined with supine-to-standing test.Methods PD patients were admitted to the Department of Neurology of 1st Affiliated Hospital of University of South China and Affiliated 2nd Hospital of Hainan Medical University from April 2017 to February 2019.General clinical data were collected.The Unified Parkinson’s Disease Rating ScaleⅢ(UPDRS-Ⅲ)was used to evaluate motor function,and Hoehn&Yahr(H&Y)Staging was used to evaluate disease severity.In addition,non-motor symptoms questionnaire(NMSQ)was used to assess non-motor symptoms(NMS)and the Scales for Out-comes in Parkinson's disease-Autonomic(SCOPA-AUT)was used for estimating the severity of autonomic nervous dysfunction.The supine to standing TCD test was performed in all the patients,and the changes of blood pressure,heart rate and cerebral hemodynamics were recorded from supine to standing for 1 min,3 min and 5 min.The patients were classified into different groups according to the characteristics of active-standing TCD test,andclinical characteristics were compared among groups.Results Eighty-seven PD patients were enrolled,including 65(74.7%)males and 22(25.3%)females.The supine-to-standing test was abnormal in 35 patients.Compared to supine-to-standing test normal patients,the UPDRS-Ⅲscore,the number of NMS and the SCOPA-AUT score were higher in the patients with abnormal supine-to-standing test(P<0.05).According to the characteristics of changes in blood pressure,heart rate,and cerebral hemodynamics during orthostasis,the patients with abnormal supine-to-standing test were classified into 9 cases(10.3%)of orthostatic hypotension-compensated(OH-C),13 cases(14.9%)of orthostatic hypotension with orthostatic cerebral blood flow decreased(OH-uncompensated,OH-U),3 cases(3.4%)of orthostatic hypertension(OHT)and 10 cases(11.5%)of orthostatic hypoperfusion.Conclusions Neurocirculatory abnormalityis common in PD,and the prominent manifestations were blood pressure dysregulation and cerebral autoregulation dysfunction.These patients have more serious motor function,autonomic dysfunctionand emotional cognitive impairment.