Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Neurology, Daisan Hospital, The Jikei University School of Medicine, Tokyo, Japan.
J Parkinsons Dis. 2021;11(2):665-673. doi: 10.3233/JPD-202239.
Orthostatic hypotension (OH) at an early stage of Parkinson's disease (PD) predicts poor prognosis, which may suggest degeneration of dopaminergic neurons affects sympathetic function, causing OH.
We tested the hypothesis that striatal dopaminergic depletion is associated with OH in PD.
Out of 99 patients with newly diagnosed untreated PD, 81 patients were enrolled according to our selection criteria. All patients underwent head-up tilt-table testing and striatal 123I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) dopamine transporter single photon emission computed tomography (DAT-SPECT). DaTQUANT software (GE Healthcare) was used as a semi-quantitative tool to analyze DAT-SPECT data. The association between hemodynamic changes and 123I-FP-CIT uptake was examined.
123I-FP-CIT uptake in the putamen, especially the anterior part and left side, was related not only to motor severity but also to OH. Change in systolic blood pressure correlated negatively with 123I-FP-CIT uptake in bilateral anterior putamen (left: p < 0.01, right: p < 0.05) and left posterior putamen (p < 0.05). Patients with OH had more severe dopamine depletion in left anterior (p = 0.008) and posterior (p = 0.007) putamen at a similar motor severity than did patients without OH even though both groups have similar baseline characteristics. An analysis of asymmetry index showed patients with OH had symmetrically decreased dopamine levels in anterior putamen when compared to those without OH (p = 0.024).
OH is closely related to striatal dopamine depletion in PD. This relation may help to account for the prognostic value of OH.
帕金森病（PD）早期出现直立性低血压（OH）预示着预后不良，这可能表明多巴胺能神经元的退化会影响交感神经功能，导致 OH。
我们检验了纹状体多巴胺能缺失与 PD 中 OH 相关的假设。
在 99 名新诊断未经治疗的 PD 患者中，根据我们的选择标准纳入 81 名患者。所有患者均接受了直立倾斜试验和纹状体 123I-2β- 碳甲氧基-3β-(4-碘苯基)-N-(3-氟丙基) 去甲托烷（123I-FP-CIT）多巴胺转运体单光子发射计算机断层扫描（DAT-SPECT）。DaTQUANT 软件（GE Healthcare）被用作半定量工具来分析 DAT-SPECT 数据。检查了血流动力学变化与 123I-FP-CIT 摄取之间的关联。
纹状体中 123I-FP-CIT 的摄取，特别是在前部和左侧，不仅与运动严重程度相关，而且与 OH 相关。收缩压的变化与双侧前纹状体（左侧：p<0.01，右侧：p<0.05）和左侧后纹状体（p<0.05）的 123I-FP-CIT 摄取呈负相关。与无 OH 的患者相比，OH 患者的左侧前（p=0.008）和后（p=0.007）纹状体多巴胺缺失更严重，尽管两组患者具有相似的基线特征。不对称指数分析表明，与无 OH 的患者相比，OH 患者的前纹状体多巴胺水平对称性降低（p=0.024）。
OH 与 PD 中的纹状体多巴胺缺失密切相关。这种关系可能有助于解释 OH 的预后价值。
