Goldstein David S
Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10/Room 6N252, 10 Center Drive, MSC-1620, Bethesda, MD 20892, USA.
Clin Auton Res. 2006 Feb;16(1):46-54. doi: 10.1007/s10286-006-0317-8.
Patients with Parkinson's disease (PD) commonly have clinically significant orthostatic hypotension (OH). In such patients PD+OH might be confused with multiple system atrophy (MSA), in which OH is a frequent finding, or with pure autonomic failure (PAF), if OH preceded clinical manifestations of the movement disorder. This study addressed whether OH can occur as an early finding in PD+OH. Historical data were analyzed from 35 patients with PD+OH evaluated at the NIH. OH was considered early if the patient had OH before, concurrent with, or starting within 1 year after onset of a symptomatic movement disorder. MSA was excluded by myocardial 6-[(18)F]fluorodopamine-derived radioactivity more than 2 standard deviations below the normal mean. Among the 35 PD+OH patients, 21 (60 %) had documentation of OH as an early finding. In 4 such patients, OH had preceded parkinsonism, and in 4 others, OH had dominated the early clinical picture, even after cessation of levodopa treatment for the movement disorder. In PD, OH can occur early in the disease, occasionally preceding or overshadowing the movement disorder.
帕金森病（PD）患者通常存在具有临床意义的直立性低血压（OH）。在这类患者中，帕金森病合并直立性低血压（PD+OH）可能会与多系统萎缩（MSA，OH在其中较为常见）混淆，或者在运动障碍临床表现出现之前若有OH，可能会与纯自主神经功能衰竭（PAF）混淆。本研究探讨了OH是否会作为PD+OH的早期表现出现。对美国国立卫生研究院评估的35例PD+OH患者的历史数据进行了分析。如果患者在有症状的运动障碍发作之前、同时或发作后1年内出现OH，则认为OH为早期表现。心肌6-[(18)F]氟多巴胺衍生放射性低于正常均值2个标准差以上则排除多系统萎缩。在这35例PD+OH患者中，21例（60%）有OH作为早期表现的记录。在4例此类患者中，OH先于帕金森综合征出现，在另外4例患者中，即使在针对运动障碍停止左旋多巴治疗后，OH在早期临床表现中仍占主导。在帕金森病中，OH可在疾病早期出现，偶尔先于运动障碍出现或使其黯然失色。
