摘要： 目的 分析帕金森病患者直立性低血压发生率并筛查其相关危险因素。方法 共纳入2020年2-9月河北医科大学第一医院收治的54例帕金森病患者,分别采用主动站立试验和直立倾斜试验测量血压并比较两种方法检测直立性低血压发生率,蒙特利尔认知评价量表(MoCA)北京版和简易智能状态量表检查(MMSE)评估认知功能,汉密尔顿抑郁量表24项(HAMD-24)和汉密尔顿焦虑量表14项(HAMA-14)评估抑郁和焦虑症状,匹兹堡睡眠质量指数(PSQI)评估睡眠质量,统一帕金森病评价量表(UPDRS)及其第三部分(UPDRSⅢ)评估帕金森病运动症状和非运动症状,改良Hoehn-Yahr分期评估疾病分期,功能性胃肠病罗马Ⅲ诊断标准评估便秘,金帕默帕金森病嗅觉障碍辅助诊断卡评估嗅觉功能。单因素和多因素前进法Logistic回归分析筛查帕金森病患者发生直立性低血压的危险因素。结果 帕金森病患者经直立倾斜试验检测直立性低血压的发生率高于主动站立试验[62.96%(34/54)对24.07%(13/54);χ²=19.048,P=0.000]。Logistic回归分析显示,多巴胺受体激动药-左旋多巴日等效剂量(LEDD)高(OR=1.029,95% CI:1.007~1.051;P=0.010)、便秘(OR=16.268,95% CI:1.213~227.972;P=0.035)、UPDRS总评分高(OR=1.303,95% CI:1.034~1.643;P=0.025)、UPDRS Ⅲ评分高(OR=1.438,95% CI:1.041~1.986;P=0.027)是帕金森病患者发生直立性低血压的危险因素,而MMSE评分高是帕金森病患者发生直立性低血压的保护因素(OR=0.606,95% CI:0.418~0.880;P=0.008)。结论 直立倾斜试验诊断帕金森病伴直立性低血压的发生率高于主动站立试验。多巴胺受体激动药-LEDD、UPDRS总评分和UPDRSⅢ评分高以及存在便秘和认知功能障碍的帕金森病患者更易发生直立性低血压。

关键词: 帕金森病, 低血压, 直立性, 危险因素, Logistic 模型

Abstract: Objective To investigate the incidence and risk factors of orthostatic hypotension (OH) in Parkinson's disease (PD) by Active Standing Test (AST) and Head-Up Tilt Test (HUTT). Methods A total of 54 patients with PD were admitted to The First Hospital of Hebei Medical University from February to September 2020. Blood pressure was measured by AST and HUTT, the incidence of OH detected by the two methods was compared. Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to assess the cognitive function. Hamilton Depression Rating Scale-24 (HAMD-24) was used to evaluate depressive symptoms. Hamilton Anxiety Rating Scale-14 (HAMA-14) was used to evaluate anxiety symptoms. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality. Unified Parkinson's Disease Rating Scale (UPDRS) and its third part were used to assess motor and non-motor symptoms of PD. Modified Hoehn-Yahr staging was assessed for disease severity. Functional gastroenteropathy Rome Ⅲ diagnostic criteria to assess constipation. KINPAMOR was used to assess olfactory function. Univariate and multivariate forward Logistic regression analyses were used to analyze the risk factors for OH in PD. Results The incidence of OH detected by HUTT was higher than that detected by AST[62.96% (34/54) vs. 24.07% (13/54); χ²=19.048, P=0.000]. Logistic regression analysis showed that the levodopa equivalent daily dose (LEDD) of dopamine receptor agonists increased (OR=1.029, 95%CI:1.007-1.051; P=0.010), constipation (OR=16.268, 95%CI:1.213-227.972; P=0.035), the lower MMSE score (OR=0.606, 95%CI:0.418-0.880; P=0.008), the higher UPDRS total scores (OR=1.303, 95%CI:1.034-1.643; P=0.025) and the higher UPDRS Ⅲ score (OR=1.438, 95%CI:1.041-1.986; P=0.027) were risk factors for OH in PD. Conclusions The incidence of OH detected by HUTT was significantly higher than that detected by AST in PD patients. The higher dosage of dopamine receptor agonist LEDD, constipation, the higher total UPDRS score, the higher UPDRSⅢ score and the lower MMSE score were risk factors for the development of OH in PD patients.

Key words: Parkinson disease, Hypotension, orthostatic, Risk factors, Logistic models