摘要： 目的 探讨帕金森病患者血压节律变化对记忆功能的影响。方法 收集2018年8月至2021年7月就诊于广东省人民医院的68例帕金森病患者临床资料,并根据24 h动态血压监测所得夜间收缩压下降率,分为反杓型组(17例)、非杓型组(30例)、正常型组(17例)和超杓型组(4例),以及夜间高血压组(37例)和非夜间高血压组(31例)。采用简易智能状态检查量表(MMSE)、蒙特利尔认知评价量表(MoCA)评估总体认知功能,逻辑记忆测验(LMT)、听觉词汇学习测验(AVLT)和数字广度测验(DST)评估记忆功能。结果 不同血压节律组患者病程(χ²=8.599,P=0.035)、AVLT瞬时记忆3(F=3.100,P=0.033)和AVLT延迟回忆(χ²=7.828,P=0.050)评分差异具有统计学意义,其中反杓型组(Z=4.224,P=0.043)和正常型组(Z=4.821,P=0.028)病程均长于超杓型组,反杓型组AVLT瞬时记忆3评分低于正常型组(t=-2.028,P=0.048)和超杓型组(t=-2.673,P=0.010),非杓型组AVLT瞬时记忆3评分低于超杓型组(t=2.554,P=0.013)。与非夜间高血压组相比,夜间高血压组患者高血压患病率更高(χ²=6.399,P=0.011)、病程更长(Z=-2.008,P=0.045);但两组认知功能差异无统计学意义(均P > 0.05)。结论 帕金森病患者出现反杓型血压节律可能影响其认知功能,尤其是记忆功能;临床应加强对帕金森病患者的动态血压监测。

关键词: 帕金森病, 血压, 认知障碍

Abstract: Objective To investigate the effect of blood pressure patterns on memory function in patients with Parkinson's disease (PD). Methods A total of 68 PD patients were collected from the Department of Neurology of Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) between August 2018 and July 2021. All patients received 24 h ambulatory blood pressure monitoring (ABPM) and were divided into reverse dipping group (n=17), reduced dipping group (n=30), normal group (n=17), and extreme dipping group (n=4) according to the reduction rate of nocturnal systolic blood pressure; nocturnal hypertension group (n=37) and non-nocturnal hypertension group (n=31) according to nocturnal blood pressure. Global cognitive function was assessed by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Memory function was evaluated by Logical Memory Test (LMT), Auditory Verbal Learning Test (AVLT) and Digit Span Test (DST). Results Among the 4 groups with different blood pressure pattern, statistical significances were found in duration (χ²=8.599, P=0.035), AVLT imediate 3 (F=3.100, P=0.033) and AVLT delayed (χ²=7.828, P=0.050). Pairwise comparison showed that the duration was longer in the reverse dipping group (Z=4.224, P=0.043) and the normal group (Z=4.821, P=0.028) than in the reduced dipping group; the AVLT imediate 3 of the reverse dipping group was lower than that of the normal group (t=- 2.028, P=0.048) and the extreme dipping group (t=- 2.673, P=0.010); the AVLT imediate 3 of the reduced dipping group was lower than that of the extreme dipping group (t=2.554, P=0.013). Compared with non-nocturnal hypertension group, the morbidity of hypertension was higher (χ²=6.399, P=0.011) and the duration was longer (Z=- 2.008, P=0.045) in the nocturnal hypertension group. There was no significant difference in memory function between 2 groups (P > 0.05, for all). Conclusions PD patients with reverse dipping blood pressure pattern are more likely to influence cognitive function, especially in memory function. Continuous blood pressure monitoring should be performed in PD patients.

Key words: Parkinson disease, Blood pressure, Cognition disorders