| 摘要: |
| 目的：探讨帕金森病（Parkinson's disease，PD）患者体位性低血压（orthostatic hypotension，OH）严重程度与卧位高血压（supine hypertension，SH）水平对脑默认网络（default mode network，DMN）静息态功能连接强度的差异化影响，揭示血压异常与认知障碍相关的潜在神经环路机制。方法：采用横断面研究设计，选取 2021年4月—2025年6月本院神经内科收治的60-89岁PD患者120例，根据OH严重度（轻度、中度、重度）和SH水平（轻度、中度、重度）分别分组，另设PD血压正常对照组。所有患者行24小时动态血压监测及静息态功能磁共振成像（resting-state functional magnetic resonance imaging，rs-fMRI）检查，采用DPARSF软件提取DMN核心脑区（后扣带回、内侧前额叶皮质、楔前叶等）功能连接强度，比较不同分组间差异及与简易精神状态检查量表（Mini-Mental State Examination，MMSE）评分的相关性。结果:随着OH严重度升高，后扣带回与楔前叶、内侧前额叶皮质与海马的功能连接强度逐渐降低（F=12.36、10.89，均P<0.01）；重度SH组内侧前额叶皮质与顶下小叶连接强度显著高于轻、中度组及对照组（F=9.74，P<0.01）。DMN核心脑区功能连接强度与MMSE评分呈正相关（r=0.42-0.56，均 P<0.01）。结论：OH严重度与SH水平对PD患者DMN功能连接的影响存在差异，OH主要导致DMN核心节点间连接减弱，SH 则以特定脑区连接增强为特征，两者可能通过不同神经环路途径影响认知功能。 |
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何倩倩
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连云港市第二人民医院
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| Abstract: |
| Objective:To explore the differential effects of orthostatic hypotension (OH) severity and supine hypertension (SH) level on the resting-state functional connectivity strength of the brain default mode network (DMN) in patients with Parkinson"s disease (PD), and to reveal the potential neural circuit mechanism underlying the association between blood pressure abnormalities and cognitive impairment. Methods:A cross-sectional study was conducted on 120 PD patients aged 60-89 years admitted to the Department of Neurology of a hospital from April 2021 to June 2025. Patients were grouped according to OH severity (mild, moderate, severe) and SH level (mild, moderate, severe), with an additional control group of PD patients with normal blood pressure. All patients underwent 24-hour ambulatory blood pressure monitoring and resting-state functional magnetic resonance imaging (rs-fMRI). DPARSF software was used to extract the functional connectivity strength of core DMN brain regions (posterior cingulate cortex, medial prefrontal cortex, precuneus, etc.). Differences between groups and correlations with Mini-Mental State Examination (MMSE) scores were analyzed. Results:With the increase of OH severity, the functional connectivity strength between posterior cingulate cortex and precuneus, as well as between medial prefrontal cortex and hippocampus, gradually decreased (F=12.36, 10.89, both P<0.01). The functional connectivity strength between medial prefrontal cortex and inferior parietal lobule in the severe SH group was significantly higher than that in the mild, moderate SH groups and the control group (F=9.74, P<0.01). The functional connectivity strength of core DMN brain regions was positively correlated with MMSE scores (r=0.42-0.56, all P<0.01). Conclusion:OH severity and SH level have different effects on DMN functional connectivity in PD patients. OH mainly leads to weakened connectivity between core DMN nodes, while SH is characterized by enhanced connectivity in specific brain regions. Both may affect cognitive function through different neural circuit pathways. |
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