基于直立倾斜试验的直立性低血压患者合并帕金森病临床特征研究

Clinical features of patients with orthostatic hypotension comorbid with Parkinson disease: a study based on the head-up tilt test

摘要:

目的 探讨直立性低血压（OH）合并帕金森病（PD）患者在直立倾斜试验（HUTT）中的临床特征。方法 对2019年5月至2024年12月就诊于南京中医药大学附属南京市中医院，以头晕、走路不稳、黑朦感为主诉，且经HUTT确诊为OH的58例患者进行回顾性分析，其中PD组患者31例，非PD组患者27例。监测两组患者进行HUTT时的血压，观察其耐受时间及血压变化，并对两组患者耐受时间及血压等相关数据进行对比。结果 PD组患者病程显著长于非PD组（P<0.05），非PD组高血压病患者比例高于PD组（P<0.05）。PD组患者HUTT完成率较非PD组患者明显降低（P<0.05），PD组较非PD组患者最大收缩压差更大（P<0.05），PD组与非PD组患者完成HUTT的时间比较，差异无统计学意义（P>0.05）。PD组患者最大收缩压差与病程和年龄之间无显著相关性（P>0.05）。结论 OH合并PD患者HUTT耐受性更差、血压波动更剧烈。采用HUTT有利于对OH合并PD患者自主神经功能障碍进行评估。

Abstract:

Objective To investigate the clinical features of patients with orthostatic hypotension （OH） comorbid with Parkinson disease （PD） based on the head-up tilt test （HUTT）.Methods A retrospective analysis was performed for 58 patients who attended Nanjing Hospital of Chinese Medicine from May 2019 to December 2024 with the chief complaints of dizziness， unsteady walking， and presyncope and were diagnosed with OH after HUTT， among whom there were 31 patients in the PD group and 27 patients in the non-PD group. Blood pressure was monitored for the patients in both groups during HUTT， and the duration of adherence and changes in blood pressure were observed. Related data including the duration of adherence and blood pressure were compared between the two groups.Results The PD group had a significantly longer disease duration than the non-PD group （P<0.05）. The proportion of patients with hypertension was significantly higher in the non-PD group than in the PD group （P<0.05）. Compared with the non-PD group， the PD group had a significantly lower completion rate of HUTT （P<0.05）， a significantly larger maximum systolic blood pressure difference （P<0.05）. The duration of HUTT completion showed no statistically significant difference between the PD and non-PD groups （P>0.05）. In the PD group， no significant correlation was found between the maximum systolic blood pressure difference and either disease duration or age （P>0.05）.Conclusions Patients with OH comorbid with PD demonstrate poorer HUTT tolerance and more pronounced blood pressure fluctuations than those without PD. HUTT may serve as a valuable tool for assessing autonomic dysfunction in patients with OH comorbid with PD.