莱沃多巴对帕金森病姿势血压变化的影响:一项随机交叉研究
Timi Earl1, Amani Jridi2, Perla C Thulin1
1Department of Neurology, University of Utah, Salt Lake City, UT, USA.
概括
利沃多巴降低了帕金森病 (PD) 患者的血压,有或没有自主性衰竭. 这种药物可能会增加因巴罗反射功能受损而导致跌倒和昏迷的风险.
科学领域:
- 神经学 神经学
- 心血管科学 心血管科学
- 药理学 药理学是指药理学的学科.
背景情况:
- 帕金森病 (PD) 通常与自主功能障碍有关,包括神经性正静性低血压 (OH).
- 利沃多巴是PD运动症状的首要治疗方法,但其对患有和没有OH的PD患者的血压调节的影响尚未完全理解.
研究的目的:
- 调查乐伏多巴对帕金森病 (PD+OH) 和无神经性正静性低血压 (PD-OH) 患者体位血压变化的影响.
主要方法:
- 采用了前性随机交叉研究设计.
- 自主测试进行了levodopa的ON和OFF.
- 主要结局是3分钟内从仰卧倾斜到70°倾斜的系统血压 (SBP) 的变化 (ΔSBP-3'). 二次结局包括巴罗反射功能指数和倾斜期间的血压/心率.
主要成果:
- 在整体研究人群中 (n=40),莱沃多巴没有显著改变 ΔSBP-3' (平均差异 -3.20 mmHg,p=0.14).
- 在PD+OH和PD-OH子组中观察到类似的非显著效应.
- 然而,莱沃多巴与7分钟和10分钟站立时血压显著降低 (p≤0.02) 和心血管noradrenergic巴罗反射功能受损有关.
结论:
- 利沃多巴可以降低PD患者的血压,无论自主性衰竭状态如何,但不会加剧立即3分钟的姿势下降.
- 勒沃多巴诱导的巴罗反射交感性诺亚上腺系统的损伤可能会导致站立时血压降低.
- 随着勒沃多巴的使用,观察到的站立血压下降可能会增加PD患者中跌倒和昏的风险.
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