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目的监测原发性帕金森病(PD)患者的24 h动态血压(ABP),观察杓型和非杓型血压在不同亚型PD患者中的分布情况,探讨其临床意义。方法研究对象为原发性PD患者40例设为PD组,与之年龄、性别相匹配的健康对照者40名设为对照组。PD组再分为有姿势异常步态障碍型(PIGD)亚组、震颤优势型亚组(震颤亚组)和不确定型亚组。对PD组和对照组行24 h ABP监测,比较PD组和对照组ABP变化,比较杓型和非杓型血压PD患者的特征。结果 PD组夜间平均血压(n MBP)与对照组比较显著增高(P=0.034);夜间平均动脉血压下降%(MABP%)明显低于对照组(P=0.022);非杓型血压的发生率明显高于对照组(P=0.039)。杓型血压的PD患者中,女性多于男性(P=0.03)。PIGD亚组的非杓型血压发生率明显高于震颤亚组+不确定型亚组(P=0.022)。杓型血压PD患者PIGD分值与非杓型血压PD患者比较,差异有显著统计学意义(P=0.003);MABP%与PIGD分值呈负相关(r=0.622,P=0.000)。MABP%对震颤亚组+不确定型亚组诊断的敏感度为66.7%,特异度为78.9%,曲线下面积为0.729(95%CI:0.568~0.891)。结论 PIGD患者较非PIGD患者有更明显的血压生物节律调节异常,MABP%是鉴别PIGD和非PIGD较好的指标。
Objective To monitor 24-hour ambulatory blood pressure (ABP) in patients with primary Parkinson’s disease (PD) and to observe the distribution of dipper and non-dipper blood pressure in patients with different subtypes of PD and explore its clinical significance. Methods Forty patients with primary PD were enrolled as PD group. Forty healthy controls matched with their age and gender were selected as control group. The PD group was further subdivided into the PIGD subgroup, the tremor subgroup (tremor subgroup) and the indefinite subgroup. 24 h ABP monitoring was performed on PD group and control group. The changes of ABP in PD group and control group were compared. The characteristics of dipper and non-dipper blood pressure PD patients were compared. Results The nocturnal mean blood pressure (n MBP) in PD group was significantly higher than that in control group (P = 0.034). The mean nighttime arterial blood pressure (MABP%) was significantly lower than that in control group (P = 0.022) Significantly higher than the control group (P = 0.039). Among the patients with dipper blood pressure, there were more women than men (P = 0.03). The incidence of non-dipper blood pressure in PIGD subgroup was significantly higher than that in subgroup tremor (+ 0.022). The PIGD scores of patients with dipper blood pressure PD were significantly different from those of non-dipper blood pressure patients (P = 0.003). MABP% was negatively correlated with PIGD scores (r = 0.622, P = 0.000). MABP% had a sensitivity of 66.7%, a specificity of 78.9%, and an area under the curve of 0.729 (95% CI: 0.568 to 0.891) for the subgroup tremor + indeterminate subgroups. Conclusion Patients with PIGD have more abnormal regulation of blood pressure biorhythm than non-PIGD patients. MABP% is a good indicator to distinguish between PIGD and non-PIGD.