파킨슨병의 심장자율신경계와 혈관 내피기능의 역할
Cardiac autonomic and vascular endothelial functions in Parkinson's disease
- 주제(키워드) Parkinson’s disease , heart rate variability , cardiac MIBG , flow-mediated endothelial function
- 발행기관 아주대학교
- 지도교수 홍지만
- 발행년도 2019
- 학위수여년월 2019. 2
- 학위명 박사
- 학과 및 전공 일반대학원 의학과
- 실제URI http://www.dcollection.net/handler/ajou/000000028412
- 본문언어 영어
- 저작권 아주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
Cardiac autonomic function, assessed using heart rate variability (HRV) and cardiac iodine- 123-meta-iodobenzylguanidine (MIBG), is altered in Parkinson’s disease (PD) patients. In addition, vascular endothelial function, as measured by flow-mediated dilation (FMD), might play a role in the pathogenesis and progression of neurodegenerative disease. However, little is known about whether cardiac autonomic function might be used in the early diagnosis of Parkinson’s disease (PD), and the extent to which such alterations contribute to the neurodegenerative process is unclear. Further, the involvement of vascular endothelial function in PD remains to be clarified. The clinical significance of cardiac autonomic function in the diagnosis and prognosis of PD and the involvement of vascular endothelial function were investigated in this study. HRV was significantly lower in early PD. Higher HRV was associated with better cognitive function. A reduction in cardiac MIBG uptake was associated with subsequent increased risk of dementia. In addition, FMD was significantly lower in PD patients, and was negatively associated with levodopa treatment. Surgical deep brain stimulation reduced levodopa administration and improved motor disability and FMD. In conclusion, cardiac autonomic dysfunction occurs early in PD and is associated with subsequent risk of developing PD-associated dementia. Vascular endothelial function is also altered in PD and appears to be affected by chronic levodopa treatment.
more목차
Abstract………………………………………………………………………………………i
Table of contents……………………………………………………………………………ii
List of Figures………………………………………………………………………………iv
List of Tables………………………………………………………………………………..v
Abbreviation………………………………………………………………………………..vi
I. INTRODUCTION…………………………………………………………………………1
1.1. Classical pathogenesis of PD…………………………………………………..1
1.2. New Concept of Neurovascular networks in PD……………………………….1
1.3. Cardiovascular autonomic system………………………………………………1
1.4. Vascular endothelial system……………………………………………………..2
1.5. Aim of the study…………………………………………………………………3
II. Materials and Method…………………………………………………………..………….4
2.1. Patients………………………………………………………………………….4
2.2. Heart rate variability (HRV)…………………………………………………….4
2.3. Cardiac iodine- 123-meta-iodobenzylguanidine (MIBG)……………………….5
2.4. Flow mediated dilation (FMD)………………………………………………….5
2.5. Statistical analysis……………………………………………………………….6
III. Results……………………………………………………………………………………7
3.1 Heart rate variability to differentiate PD from essential tremor (ET)…………..7
3.2 Heart rate variability in PD with and without REM sleep behavior disorder….11
3.3 Cardiac MIBG and risk of dementia PD………………………………………..14
3.4. Effect of heart rate variability on cognition in PD……………………………..20
3.5. Flow-mediated dilation in PD………………………………………………….22
3.6. Endothelial dysfunction and hyperhomocysteinemia in PD……………..…….24
3.7. Effect of levodopa on FMD in PD: Serial follow up study…………………….29
3.8. Effect of FMD on cognition in PD……………………………………………31
3.9. Effect of deep brain stimulation (DBS) on FMD and HRV…………………...33
IV. Discussion……………………………………………………………………………….36
V. Conclusion………………………………………………………………………………..39
References……………………………………………………………………………………41
국문요약…………………………………………………………………………………….48
