Orthostatic hypotension from sympathetic denervation in Parkinson's disease
Orthostatic hypotension from sympathetic denervation in Parkinson's disease
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DOI：
10.1212/wnl.58.8.1247
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发表时间：
2002-04-23
期刊：
影响因子：
9.9
通讯作者：
Li, ST
中科院分区：
文献类型：
--
作者：
Goldstein, DS;Holmes, CS;Li, ST
背景：PD患者常伴有自主神经功能衰竭的体征或症状，包括直立性低血压。心脏交感神经去神经在PD中经常发生，但这一直被认为是独立于自主神经功能衰竭发生的。研究方法：41例PI患者（18例有体位性低血压，23例无体位性低血压）和16例年龄匹配的健康志愿者在注射6-[F-18]氟多巴胺后接受PET扫描，以观察交感神经支配。对Valsalva动作的逐搏血压反应用于识别交感神经循环衰竭，血浆去甲肾上腺素用于指示总体交感神经支配。结果如下：所有PD和直立性低血压患者对Valsalva动作的血压反应异常，间隔和侧心室心肌6-[F-18]氟多巴胺衍生放射性浓度低于正常平均值>2 SD。相比之下，23例无体位性低血压的患者中只有6例出现异常Valsalva反应（与体位性低血压患者相比，p < 0.0001），只有11例左心室心肌中6-[F-18]氟多巴胺衍生放射性弥漫性降低（p = 0.0004）。其余12例无体位性低血压的患者中，7例局部心肌放射性降低。体位性低血压患者的仰卧位血浆去甲肾上腺素水平低于无体位性低血压患者（1.40 +/- 0.15 vs 2.32 +/- 0.26 nmol/L，p = 0.005）。6-[F-18]氟多巴胺衍生的放射性不仅在心肌中，而且在PI患者的甲状腺和肾皮质中也低于健康对照受试者。结论：在PD中，体位性低血压反映了广泛交感神经失神经支配引起的交感神经循环衰竭。
Background: Patients with PD often have signs or symptoms of autonomic failure, including orthostatic hypotension. Cardiac sympathetic denervation occurs frequently in PD, but this has been thought to occur independently of autonomic failure. Methods: Forty-one patients with PI) (18 with and 23 without orthostatic hypotension) and 16 age-matched healthy volunteers underwent PET scanning to visualize sympathetic innervation after injection of 6-[F-18]fluorodopamine. Beat-to-beat blood pressure responses to the Valsalva maneuver were used to identify sympathetic neurocirculatory failure and plasma norepinephrine to indicate overall sympathetic innervation. Results: All patients with PD and orthostatic hypotension had abnormal blood pressure responses to the Valsalva maneuver and septal and lateral ventricular myocardial concentrations of 6-[F-18]fluorodopamine-derived radioactivity >2 SD below the normal mean. In contrast, only 6 of the 23 patients without orthostatic hypotension had abnormal Valsalva responses (p < 0.0001 compared with patients with orthostatic hypotension), and only 11 had diffusely decreased 6-[F-18]fluorodopamine-derived radioactivity in the left ventricular myocardium (p = 0.0004). Of the 12 remaining patients without orthostatic hypotension, 7 had locally decreased myocardial radioactivity. Supine plasma norepinephrine was lower in patients with than in those without orthostatic hypotension (1.40 +/- 0.15 vs 2.32 +/- 0.26 nmol/L, p = 0.005). 6-[F-18]fluorodopamine-derived radioactivity was less not only in the myocardium but also in the thyroid and renal cortex of patients with PI) than in healthy control subjects. Conclusions: In PD, orthostatic hypotension reflects sympathetic neurocirculatory failure from generalized sympathetic denervation.