帕金森病患者直立性低血压的研究进展

帕金森病(Parkinson's disease,PD)为慢性进行性神经系统变性疾病,涉及多个神经解剖区域,既可出现典型的运动障碍表现,也与诸多非运动症状有关,包括睡眠障碍、认知功能障碍、自主神经功能障碍等。直立性低血压(orthostatic hypotension,OH)为心血管适应机制不能代偿从卧位到直立位时减少的静脉回流出现的临床症状,与冠心病、脑卒中的发病风险显著增加有关。OH为PD常见的自主神经功能障碍的症状之一,患者可出现体位性头晕、晕厥、全身乏力、肌肉疼痛等症状,可导致跌到和外伤,严重影响患者的生活质量。目前认为交感神经节后神经纤维受损是PD患者发生OH的主要原因,其他相关因素还包括年龄的增长、疾病严重程度、病程等,此外,近期研究发现维生素D缺乏、低瘦素水平和低体重指数可能也与PD合并OH有关。去除诱因和非药物干预应作为患者缓解症状的首选,药物治疗也有助于改善症状,但这些方案并非专门针对PD合并OH的患者。对于PD患者,应根据其个体情况制定方案。药物治疗虽有效,但可导致或加重卧位高血压(supine hypertension,SH)——OH的常见合并症,可使治疗复杂化。本文就PD合并OH的诊断、发病机制、管理与治疗方面的进展进行综述。 

Research progress in orthostatic hypotension with Parkinson's disease

Parkinson's disease (PD) is a chronic progressive neurodegenerative disorder characterized by a variety of motional and non-motional features (sleep disorder, cognitive dysfunction, autonomic dysfunction, etc.), involving many neuroanatomic areas. Orthostatic hypotension (OH) occurs when cardiovascular adaptive mechanisms fail to compensate for the reduction in venous return when transforming from supine to erect position. It is associated with significantly increased risk of coronary heart disease and stroke incidence. OH, as one of the common autonomic dysfunction symptoms of PD, may cause other symptoms like dizziness, syncope, generalized weakness, muscular pain and so on. OH can result in falls and trauma, which have a strong impact on the quality of life of PD-patients. A degree of damage to the postganglionic sympathetic nerves is suggested as the main cause of OH, with some other factors including age increasing, disease severity or duration. In addition, Vitamin D deficiency, low leptin level and low BMI are also associated with OH in PD patients, according to some recent studies. Removing some predisposing factors and adopting non-pharmacological intervention are the first steps in treatment, while pharmacological treatments can also help with symptomatic relief. But none of them is specifically treating OH in PD patients. Medication management of OH in PD-patients should be guided by specific factors of the patients. Although effective, pharmacological treatments can also lead to or exacerbate supine hypertension (SH) -a common complication of OH, which can complicate the treatment. In this review, we intend to summarize the progress on different aspects of OH in PD-patients including diagnosis, pathogenesis, management and treatment.