Park Jinse, Kim Hee-Tae, Park Kang Min, Ha Sam Yeol, Kim Sung Eun, Shin Kyong Jin, Kim Si Eun, Jang Wooyoung, Kim Ji Sun, Youn Jinyoung, Oh Engsoek, Park Suyeon
Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Republic of Korea.
Department of Neurology, Hanyang University College of Medicine, Hanyang University, College of Medicine, Seoul, Republic of Korea.
J Clin Ultrasound. 2017 Jul 8;45(6):337-342. doi: 10.1002/jcu.22452. Epub 2017 Apr 12.
Orthostatic hypotension (OH) is controversially regarded as the cause of orthostatic dizziness in Parkinson's disease (PD). We sought to evaluate whether cerebral autoregulation is an alternative cause for orthostatic dizziness in PD patients, using transcranial Doppler monitoring during head-up tilting.
Forty-five PD patients with dizziness, 13 PD patients without dizziness, and 10 age-matched healthy controls were enrolled. Participants were divided into the following four groups: patients with dizziness and OH (group 1, n = 22), patients with dizziness but no OH (n = 23, group 2), patients without dizziness (n = 11, group 3), and age-matched healthy controls (n = 10, group 4). All participants underwent transcranial Doppler and blood pressure monitoring for 10 minutes during the head-up tilt test. Changes in the cerebral blood flow velocity (CBFV) in the middle cerebral artery and the mean blood pressure (mBP) within 3 minutes after head-up tilting were compared between groups.
Group 1 showed a significantly higher change in mBP (-16.3 ± 10.8 mmHg) than groups 2 (-2.6 ± 4.9), 3 (-2.2 ± 3.6), or 4 (1.8 ± 6.0) (p < 0.001). However, groups 3 (4.6 ± 3.0 cm/s) and 4 (-4.2 ± 2.5) showed a significantly smaller change in CBFV than groups 1 (-9.0 ± 4.2) and 2 (-8.1 ± 5.1) (p < 0.01).
Our results suggest that cerebral hypoperfusion contributes to dizziness in PD patients despite a lack of OH. Transcranial Doppler monitoring during head-up tilting may be a useful tool for evaluating dizziness in PD patients with or without OH. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:337-342, 2017.
体位性低血压（OH）是否为帕金森病（PD）患者体位性头晕的病因存在争议。我们试图通过在头高位倾斜试验期间使用经颅多普勒监测，评估脑自动调节功能是否为PD患者体位性头晕的另一个病因。
纳入45例有头晕症状的PD患者、13例无头晕症状的PD患者以及10例年龄匹配的健康对照者。参与者被分为以下四组：有头晕症状且伴有OH的患者（第1组，n = 22）、有头晕症状但无OH的患者（n = 23，第2组）、无头晕症状的患者（n = 11，第3组）以及年龄匹配的健康对照者（n = 10，第4组）。所有参与者在头高位倾斜试验期间接受10分钟的经颅多普勒和血压监测。比较各组在头高位倾斜后3分钟内大脑中动脉的脑血流速度（CBFV）和平均血压（mBP）的变化。
第1组的mBP变化（-16.3±10.8 mmHg）显著高于第2组（-2.6±4.9）、第3组（-2.2±3.6）或第4组（1.8±6.0）（p < 0.001）。然而，第3组（4.6±3.0 cm/s）和第4组（-4.2±2.5）的CBFV变化显著小于第1组（-9.0±4.2）和第2组（-8.1±5.1）（p < 0.01）。
我们的结果表明，尽管没有OH，但脑灌注不足会导致PD患者出现头晕。在头高位倾斜试验期间进行经颅多普勒监测可能是评估有或无OH的PD患者头晕的有用工具。© 2016威利期刊公司。《临床超声杂志》45:337 - 342，2017年。
