Impaired cardiovascular autonomic control in newly and long-term-treated patients with Parkinson's disease: involvement of L-dopa therapy
Impaired cardiovascular autonomic control in newly and long-term-treated patients with Parkinson's disease: involvement of L-dopa therapy
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DOI：
10.1016/j.autneu.2004.06.009
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发表时间：
2004-11-30
影响因子：
2.7
通讯作者：
Regnard, J
中科院分区：
文献类型：
--
作者：
Bouhaddi, M;Vuillier, F;Regnard, J
在特发性帕金森病（PD）中，植物神经功能紊乱是常见的，导致直立性低血压。疾病进展和多巴胺能治疗各自的作用仍不清楚。在这项研究中，我们调查了新诊断（ND）和长期治疗（LT）患者心血管功能的自主控制及其与左旋多巴治疗的关系。研究受试者为：（1）9名ND患者从未接受过左旋多巴治疗-（2）18名LT患者长期接受左旋多巴治疗。在左旋多巴治疗前和左旋多巴剂量稳定后，对ND患者进行了调查。LT患者接受常规治疗和L-多巴治疗中断12小时后各进行一次研究;（3）9名健康受试者作为对照。在每个测试阶段，血压（BP），心率（HR），血浆儿茶酚胺，心率变异性（HRV）和自发压力反射。在仰卧位和直立位评估敏感性。在接受左旋多巴药物治疗之前，与对照组相比，ND患者的E/I比值（HR反应/深呼吸）降低，HRV降低;这是该疾病对自主HR控制的早期影响的证据。左旋多巴治疗的引入降低了血压、心率和肾上腺素和去甲肾上腺素的血浆水平。当对比短期治疗中断和通常的左旋多巴剂量时，在LT患者中发现了类似的变化。给药相关的血浆多巴胺升高也与去甲肾上腺素降低相关。这些结果表明，轻度损害自主心血管控制发生在早期的过程中的PD。他们还提供了证据表明，副作用左旋多巴加重损害的自主控制BP和HR.（C）2004爱思唯尔B. V.保留所有权利.
In idiopathic Parkinson's disease (PD), autonomic dysfunction is frequent, causing orthostatic hypotension. The respective roles of disease progression and dopaminergic treatment remain unclear. In this study, we investigated the autonomic control of cardiovascular functions and its relation to L-dopa therapy in both newly diagnosed (ND) and long-term-treated (LT) patients. Study subjects were: (1) nine ND patients never having undergone treatment with L-dopa- (2) 18 LT patients who had been receiving L-dopa treatment for a long period. ND patients were investigated before L-dopa treatment and after stabilization of their L-dopa dosage. LT patients were investigated once with their regular treatment and once after a 12-h interruption of L-dopa treatment; (3) nine healthy subjects served as controls. At each test session, blood pressure (BP), heart rate (HR), plasma catecholamines, heart rate variability (HRV), and spontaneous baroreflex. sensitivity were assessed in the supine and upright positions. Before receiving L-dopa medication, ND patients had reduced E/I ratios (HR response/ deep breathing) and lowered HRV when compared to controls; this was evidence of early effects of the disease on autonomic HR control. Introduction Of L-dopa treatment reduced BP, HR, and plasma levels of adrenaline and noradrenaline. Similar changes were found in LT patients when contrasting the short-term treatment interruption and the usual L-dopa dosage. The treatment-linked increase in plasma dopamine also correlated with the decrease in noradrenaline. These results showed that mild impairment of autonomic cardiovascular control occurred early in the course of PD. They also provided evidence that the side effects Of L-dopa aggravated the impairment of the autonomic control of BP and HR. (C) 2004 Elsevier B.V. All rights reserved.