背景:呼吸困难是影响生活质量的帕金森病(PD)的重要非运动症状。由于将中枢呼吸控制异常与周围呼吸肌功能障碍和胸壁僵硬分开的挑战,呼吸困难的潜在机制难以确定。
方法:进行了全面的文献综述,在PubMed数据库中搜索有关PD中呼吸功能障碍和呼吸困难的观察性研究。纳入标准是对没有其他神经系统疾病的PD患者的研究。案例研究被排除在外。研究规模的数据,疾病持续时间,控制组,并提取呼吸缺陷。
结果:搜索产生了23篇关于PD肺功能的独特出版物。主要发现是:1)限制性缺陷很常见,在一些研究中患病率高达85%;2)左旋多巴对肺功能的影响在各研究中是可变的;3)关于中枢呼吸中枢在PD中呼吸困难病理生理学中的作用的研究有限。提出的机制包括直接累及脑干呼吸结构,这些区域的多巴胺输入丢失,和星形胶质细胞功能障碍影响呼吸节律的产生。
结论:这篇综述概述了PD呼吸困难的潜在机制,包括中枢呼吸功能障碍,外周肌肉/胸壁异常,呼吸感觉受损,和药物效果。需要更多的研究来调查涉及的特定脑干区域,化学感受器病理学,呼吸负荷与感觉到的呼吸困难之间的相关性,和药物对肺功能的影响。
BACKGROUND: Dyspnea is an important non-motor symptom in Parkinson\'s disease (PD) that impacts quality of life. The mechanisms underlying dyspnea have been difficult to determine due to challenges separating central respiratory control abnormalities from peripheral respiratory muscle dysfunction and chest wall rigidity.
METHODS: A comprehensive literature review was conducted, searching the PubMed database for observational studies on respiratory dysfunction and dyspnea in PD. Inclusion criteria were studies with PD patients without other neurological disorders. Case studies were excluded. Data on study size, disease duration, control groups, and respiratory defects were extracted.
RESULTS: The search yielded 23 unique publications on pulmonary function in PD. Key findings were: 1) restrictive defects are common, with prevalence up to 85% in some studies; 2) effects of levodopa on pulmonary function are variable across studies; 3) there is limited research on the role of central respiratory centers in dyspnea pathophysiology in PD. Proposed mechanisms include direct involvement of brainstem respiratory structures, loss of dopamine input to these regions, and astrocyte dysfunction affecting respiratory rhythm generation.
CONCLUSIONS: This review outlines potential mechanisms underlying dyspnea in PD, including central respiratory dysfunction, peripheral muscle/chest wall abnormalities, impaired respiratory sensation, and medication effects. More research is needed investigating specific brainstem regions involved, chemoreceptor pathology, correlations between respiratory load and perceived dyspnea, and medication effects on pulmonary function.