早发型帕金森病患者体位性低血压的危险因素

Risk Factors of Orthostatic Hypotension in Early-Onset Parkinson’s Disease

目的:本研究旨在探讨早发型帕金森病(EOPD)患者发生体位性低血压(OH)特征、可能的危险因素,以及OH对运动症状和非运动症状的影响。方法:入组131例EOPD患者。记录患者基本信息,进行各项运动及非运动症状临床量表的评估。测量并记录患者在急性美多巴冲击试验服药前、服药1、2、3 h后卧立位血压测试,MDS-UPDRSⅢ运动症状评分,计算左旋多巴改善率。根据是否出现OH分为OH组和非OH组,比较2组的基本临床数据、各量表评分,分析OH的可能危险因素。结果:入组的131例EOPD患者纳入OH组69例,纳入无OH组62例。总OH发生率为52.7%,服药前OH发生率为25.8%,服药后为39.7%(P<0.05)。OH组患者病程更长,卧位高血压、剂末现象的发生率更高,左旋多巴最大改善率更高,姿势步态异常得分更高(均P<0.05);OH组患者的冻结步态问卷(FOGQ)、Cleveland便秘评分系统(CCS)和帕金森病日常生活质量问卷调查(PDQ-39)量表评分得分更高(均P<0.05);Logistic回归分析显示卧位高血压(OR=11.057,P=0.000)和便秘(OR=1.170,P=0.019)是EOPD患者发生OH的高危因素。结论:OH是EOPD患者的常见自主神经受损表现,服用左旋多巴药物后更易发生。左旋多巴药物可使EOPD患者卧立位收缩压下降。卧位高血压和便秘是EOPD患者发生OH的高危因素。建议对PD患者进行服用抗PD药物后1~2 h的卧立位试验,明确卧位高血压及OH情况,辅助专科医生制定合适的治疗方案。

Objective:To investigate the features and potential risk factors of orthostatic hypotension(OH) in early-onset Parkinson’s disease(EOPD) and examine its influence on motor and non-motor function.Methods:For this study,131 EOPD patients were enrolled.Basic patient information and a comprehensive set of clinical features including both motor and non-motor symptoms were recorded.Patient lying to standing blood pressure(BP) was measured during the acute levodopa challenge test at pre-drug and 1,2,and 3 hours post-drug;the MDS-UPDRS Ⅲ score was recorded,and the motor response was calculated.Patients were divided based on occurrence of OH into the OH group or non-OH group.Patient demographics and clinical features were compared between the 2 groups,and the risk factors for OH were analyzed.Results:The 131 EOPD patients included 69with OH and 62 without.The prevalence of OH was 52.7%.OH group patients showed a longer disease course,higher incidence of supine hypertension and wearing-off,better motor response to levodopa,and higher scores of postural instability and gait difficulty(all P<0.05).OH group patients exhibited higher scores in the freezing of gait questionnaire(FOGQ),Cleveland constipation score(CCS),and Parkinson’s disease questionnaire 39(PDQ-39),and the difference was statistically significant(all P<0.05).Logistic regression analysis revealed that risk factors for OH in EOPD patients were supine hypertension(OR=11.057,P=0.000) and constipation(OR=1.170,P=0.019).Conclusion:OH is a common manifestation of autonomic impairment in EOPD patients and is more likely to occur after levodopa use.Levodopa can decrease supine and standing systolic BP in EOPD patients.Supine hypertension and constipation are risk factors for OH in EOPD patients.We recommend assessing supine hypertension and OH in PD patients by performing lying to standing tests 1-2 hours after taking anti-Parkinsonian drugs to assist physicians in planning appropriate treatment.