作者：张晓杰1 ，艾伟平1 ，赵义凡2 ，陈素艳3

单位：

1.075000河北省张家口市第一医院神经内一科　2.075000河北省张家口市第一医院神经外一科　3.075000河 北省张家口市第一医院电生理科

Units：

1.Department of Neurology, the First Hospital of Zhangjiakou City, Zhangjiakou 075000, China 2.Department of Neurosurgery, the First Hospital of Zhangjiakou City, Zhangjiakou 075000, China 3.Department of Neuroelectrophysiology, the First Hospital of Zhangjiakou City, Zhangjiakou 075000, China

关键词：

帕金森病；自主神经功能障碍；脑血流储备；miR-331-5p

Keywords：

Parkinson's disease; Autonomic nerve dysfunction; Cerebral blood flow reserve; miR-331-5p

CLC：

R 742.5

DOI：

10.12114/j.issn.1008-5971.2024.00.050

Funds：

2023年度河北省医学科学研究课题青年科技课题项目（20232061）；张家口市重点研发计划项目（2221125D）

摘要：

目的　探讨脑血流储备参数、血清miR-331-5p水平与老年帕金森病（PD）患者发生自主神经功能障 碍的关系。方法　选取2022年3月—2023年6月张家口市第一医院收治的老年PD患者40例为PD组，另纳入同时期在张 家口市第一医院体检的健康者40例为对照组。采用多参数心脑血流监测系统监测两组脑血流储备参数〔大脑中动脉、 大脑后动脉、基底动脉脑血流速度（CBFV）及相位差、增益〕，采用实时聚合酶链反应检测两组血清miR-331-5p水 平，采用PD自主神经症状量表（SCOPA-AUT）评估PD组患者自主神经功能障碍发生情况。采用多因素Logistic回归 分析探讨老年PD患者发生自主神经功能障碍的影响因素。结果　PD组大脑中动脉、大脑后动脉、基底动脉CBFV慢于 对照组，相位差小于对照组，血清miR-331-5p水平高于对照组（P＜0.05）。40例老年PD患者中13例（32.5%）发生 自主神经功能障碍。自主神经功能障碍与非自主神经功能障碍者H-Y分期比较，差异有统计学意义（P＜0.05）；自 主神经功能障碍者皮肤交感反应（SSR）异常发生率高于非自主神经功能障碍者，大脑中动脉、大脑后动脉、基底动 脉CBFV慢于非自主神经功能障碍者，相位差小于非自主神经功能障碍者，血清miR-331-5p水平高于非自主神经功能 障碍者（P＜0.05）。多因素Logistic回归分析结果显示，SSR异常、H-Y分期和大脑中动脉、大脑后动脉、基底动脉 CBFV及相位差、血清miR-331-5p水平是老年PD患者发生自主神经功能障碍的独立影响因素（P＜0.05）。结论　大脑 中动脉、大脑后动脉、基底动脉CBFV及相位差、血清miR-331-5p水平是老年PD患者发生自主神经功能障碍的独立影 响因素，脑血流储备功能下降、血清miR-331-5p水平升高可增加老年PD患者发生自主神经功能障碍的风险。

Abstract：

Objective To explore the relationship between cerebral blood flow reserve parameters and serum miR- 331-5p level and autonomic nerve dysfunction in elderly Parkinson's disease (PD) patients. Methods A total of 40 elderly PD patients admitted to the First Hospital of Zhangjiakou City from March 2022 to June 2023 were selected as the PD group, while 40 healthy examinees from the First Hospital of Zhangjiakou City during the same period were included as the control group. The parameters of cerebral blood flow reserve [cerebral blood flow velocity (CBFV) of middle cerebral artery, posterior cerebral artery and basilar artery, phase difference, gain] of the two groups were monitored by multi-parameter cardio-cerebral blood flow monitoring system. The serum miR-331-5p level of the two groups was detected by real-time polymerase chain reaction. The occurrence of autonomic nerve dysfunction was evaluated by Scale for Outcomes in PD for Autonomic Symptoms (SCOPA AUT) in the PD group. Multivariate Logistic regression analysis was used to explore the influencing factors of autonomic nerve dysfunction in elderly PD patients. Results The middle cerebral artery CBFV, posterior cerebral artery CBFV, basilar artery CBFV in the PD group were slower than those in the contol group, phase difference was smaller than that in the control group, and the serum miR-331-5p level was higher than that in the control group (P < 0.05) . Among the 40 elderly PD patients, 13 (32.5%) had autonomic nerve dysfunction. There was a statistically significant difference in H-Y staging between patients with autonomic nerve dysfunction and patients without autonomic nerve dysfunction (P < 0.05) . The incidence of sympathetic skin response (SSR) abnormalities in the patients with autonomic nerve dysfunction was higher than that in the patients without autonomic nerve dysfunction, the middle cerebral artery CBFV, posterior cerebral artery CBFV, basilar artery CBFV were slower than those in the patients without autonomic nerve dysfunction, phase difference was smaller than that in the patients without autonomic nerve dysfunction, and the serum miR-331-5p level was higher than that in the patients without autonomic nerve dysfunction (P < 0.05) . Multivariate Logistic regression analysis showed that SSR abnormalities, H-Y staging, middle cerebral artery CBFV, posterior cerebral artery CBFV, basilar artery CBFV, phase difference and serum miR-331-5p level were the independent influencing factors of autonomic nerve dysfunction in elderly PD patients (P < 0.05) . Conclusion Middle cerebral artery CBFV, posterior cerebral artery CBFV, basilar artery CBFV, phase difference and serum miR-331-5p are the independent influencing factors of autonomic nerve dysfunction in elderly PD patients. Decreased cerebral blood flow reserve function and elevated serum miR-331- 5p level can increase the risk of autonomic nerve dysfunction in elderly PD patients.

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