年龄是帕金森病患者多巴酚丁胺激发试验引起直立性低血压的危险因素：一项单中心试验的结果。

Age as a risk factor for orthostatic hypotension induced by the levodopa challenge test in patients with Parkinson's disease: Results from a single-center trial.

机构信息

Department of Geriatrics, Liangxiang Hospital of Beijing Fangshan District, Beijing, China.

National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China.

出版信息

Medicine (Baltimore). 2023 Mar 3;102(9):e33161. doi: 10.1097/MD.0000000000033161.

DOI:10.1097/MD.0000000000033161

PMID:36862872

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9981374/

Abstract

BACKGROUND

Hypotension can occur in patients receiving levodopa (L-dopa) treatment for parkinsonism. However, only few studies have focused on the characteristics of orthostatic hypotension (OH) induced by the L-dopa challenge test (LCT). This study aimed to investigate the characteristics and influencing factors of LCT-induced OH in a relatively large sample of patients with Parkinson's disease (PD).

METHODS

Seventy-eight patients with PD without a previous diagnosis of OH underwent the LCT. Blood pressure (BP) in the supine and standing positions was measured before and 2 hours after the LCT. If diagnosed with OH, the patients' BP was monitored again 3 hours after the LCT. The clinical features and demographics of the patients were analyzed.

RESULTS

Eight patients were diagnosed with OH 2 hours after the LCT (median dose of 375 mg L-dopa/benserazide; incidence = 10.3%). One patient without symptoms had OH 3 hours after the LCT. Compared with patients without OH, patients with OH had lower 1- and 3-minutes standing systolic BP and 1-minute standing diastolic BP at baseline and 2 hours after the LCT. Patients in the OH group were of older age (65.31 ± 4.17 years vs 59.74 ± 5.55years) and had lower Montreal Cognitive Assessment scores (17.5 vs 24) and higher L-dopa/benserazide levels (375 [250, 500] mg vs 250 [125, 500] mg). Older age markedly increased the odds of having LCT-induced OH (odds ratio, 1.451; 95% confidence interval, 1.055-1.995; P = .022).

CONCLUSIONS

LCT increased the odds of OH in non-OH PD, causing symptomatic OH in 10.3% of patients in our study, thereby raising safety concerns. Increase in age was observed to be a risk factor for LCT-induced OH in PD patients. A study with a larger sample size is warranted to confirm our results.

TRIAL REGISTRATION NUMBER

Clinical Trials Registry under ChiCTR2200055707.

DATE OF REGISTRATION

January 16, 2022.

摘要

背景

接受左旋多巴（L-dopa）治疗帕金森病的患者可能会出现低血压。然而，只有少数研究关注左旋多巴激发试验（LCT）引起的直立性低血压（OH）的特征。本研究旨在调查相对较大样本的帕金森病（PD）患者中 LCT 诱导的 OH 的特征和影响因素。

方法

78 例无 OH 既往病史的 PD 患者接受 LCT。在 LCT 前后测量卧位和立位血压。如果诊断为 OH，则在 LCT 后 3 小时再次监测患者的血压。分析患者的临床特征和人口统计学资料。

结果

8 例患者在 LCT 后 2 小时被诊断为 OH（L-dopa/培高利特中位数剂量 375mg；发生率=10.3%）。1 例无症状患者在 LCT 后 3 小时出现 OH。与无 OH 患者相比，OH 患者在基线和 LCT 后 2 小时的 1 分钟和 3 分钟立位收缩压以及 1 分钟立位舒张压均较低。OH 组患者年龄较大（65.31±4.17 岁 vs. 59.74±5.55 岁），蒙特利尔认知评估量表评分较低（17.5 分 vs. 24 分），L-dopa/培高利特水平较高（375[250,500]mg vs. 250[125,500]mg）。年龄较大显著增加了 LCT 诱导 OH 的几率（比值比，1.451；95%置信区间，1.055-1.995；P=0.022）。