帕金森合并脑白质疏松患者认知功能与高血压特征的关系分析

Relationship between cognitive function and hypertension characteristics in Parkinson’s patients with leukoaraiosis

目的探讨帕金森(PD)合并脑白质疏松(LA)患者认知功能与高血压特征的关系。方法选取广东省佛山市禅城区中心医院2015年1月至2019年1月收治PD合并LA患者96例,按照蒙特利尔认知评估量表(MoCA)将患者分为认知正常组(n=46)、认知障碍组(n=50),对所有患者进行24 h动态血压监测,观察24 h内的平均收缩压(MSBP)、平均舒张压(MDBP)、动态脉压指数(APPI)、平均收缩压变异系数(SBPV)及平均舒张压变异系数(DBPV)。单因素分析PD合并LA患者发生认知功能障碍的危险因素,进一步采用多因素Logistic回归分析上述血压参数与认知功能障碍的关系。结果认知正常组与认知障碍组吸烟史、高血压病、受教育程度、MSBP、MDBP、SBPV及DBPV比较,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,高血压2级和3级、SBPV≥15 mmHg、DBPV≥13 mmHg均为PD合并LA患者认知功能障碍的独立危险因素(P<0.05)。结论高血压和血压变异性增大的PD合并LA患者认知功能障碍发生率更高,而收缩压与舒张压变异系数增大是PD合并LA患者认知功能障碍的独立危险因素。

Objective To explore the relationship between cognitive function and hypertension characteristics in Parkinson’s(PD)patients with leukoaraiosis(LA).Methods A total of 96 patients with PD complicated with LA admitted to Foshan Chancheng Central Hospital from January 2015 to January 2019 were divided into the normal group(n=46)and the cognitive impairment group(n=50)according to Montreal Cognitive Assessment Scale(MoCA).24-hour ambulatory blood pressure monitoring was performed in all patients,and the mean systolic blood pressure(MSBP),mean diastolic blood pressure(MDBP),ambulatory pulse pressure index(APPI),systolic blood pressure variability(SBPV)and diastolic blood pressure variability(DBPV)were observed within 24 hours.Univariate analysis was used to analyze the risk factors of cognitive dysfunction in PD patients with LA,and multivariate Logistic regression was used to analyze the relationship between the above blood pressure parameters and cognitive dysfunction.Results There were significant differences in smoking history,hypertension,education level,MSBP,MDBP,SBPV and DBPV between the normal group and the cognitive impairment group(P<0.05).Multivariate Logistic regression analysis showed that grade 2 and grade 3 hypertension,SBPV≥15 mmHg and DBPV≥13 mmHg were independent risk factors for cognitive dysfunction in PD patients with LA(P<0.05).Conclusion The incidence of cognitive dysfunction is higher in PD patients with LA with hypertension and increased blood pressure variability,and the increased coefficient of variation of systolic and diastolic blood pressure is an independent risk factor for cognitive dysfunction in PD patients with LA.