帕金森病患者流涎与吞咽困难的关系研究  

Relationship between sialorrhea and dysphagia in Chinese patients with Parkinson′s disease

作　　者：谢朝艳[1,2] 丁雪萍[1,3] 高吉祥[1,4] 熊冰[5] 岑志栋[1,4] 娄丹宁[1,4] 娄毓婷 罗巍[1] 

机构地区：[1]浙江大学医学院附属第二医院神经内科,杭州310009 [2]宁波市北仑区人民医院神经内科 [3]海宁市人民医院神经内科 [4]解放军第一一七医院神经内科 [5]浙江大学医学院附属第二医院康复科,杭州310009

出　　处：《中华神经科杂志》2016年第11期856-863,共8页Chinese Journal of Neurology

摘　　要：目的：研究帕金森病患者流涎的发生率及其与吞咽困难等临床资料的关系。方法选取门诊确诊为原发性帕金森病患者116例，收集患者的性别、年龄、教育年限、发病年龄、临床表型、病程、用药情况、Hoehn ＆ Yahr分级等临床资料，是否流涎的评估采用统一帕金森病评定量表日常生活活动第6条。所有患者进行电视X线透视吞咽功能检查。结果我们发现帕金森病患者流涎的发生率为59.5％（69／116，95％ CI 50.6％～68.4％），男性比女性流涎发生率高（分别为47／70比22／46，χ2＝4.298， P＝0.038）。帕金森病患者流涎与口腔期吞咽困难呈正相关：食物从口腔漏出唇外：稀流质r＝0.229， P＝0.014，浓流质r＝0.197， P＝0.034，糊状食物r＝0.231， P＝0.013，固体食物r＝0.255， P＝0.006；口腔食物残留（＞1 ml）：稀流质r＝0.319， P＜0.01，固体食物r＝0.185， P＝0.047；舌根移送延迟：稀流质r＝0.279， P＝0.002，浓流质r＝0.209， P＝0.024；咽移送延迟：糊状食物r＝0.257， P＝0.005。流涎评分与患者Hoehn＆Yahr分级、病程、左旋多巴等效剂量之间差异无统计学意义。帕金森病患者吞咽困难的发生率是87.1％（95％CI 81.0％～93.2％），稀流质食物更易发生咽期吞咽困难（ P＝0.03）。随着Hoehn＆Yahr分级的增加，口腔期、咽期吞咽困难发生率增加。病程中、晚期比早期更易发生口腔期、咽期吞咽困难。结论流涎和吞咽困难是帕金森病患者常见的非运动症状，其中男性流涎发生率高，流涎与口腔期吞咽困难呈正相关。稀流质食物更易发生咽期吞咽困难；随着Hoehn＆Yahr分级的增加，口腔期、咽期吞咽困难发生率增加；病程中、晚期比早期更易发生口腔期及咽期吞咽困难。Objective To explore the prevalence of sialorrhea and its clinical correlation with dysphagia in Chinese patients with Parkinson′s disease （ PD ）.Methods One hundred and sixteen consecutive patients with a clinical diagnosis of PD were selected.Demographic data included sex , age, years of education, age at onset of PD, clinical genotype, disease duration, treatment, Hoehn and Yahr （H＆amp;Y） stage.Sialorrhea was assessed using the Unified Parkinson′s Disease Rating Scale （UPDRS） Ⅱitem number 6.All patients were studied with videofluoroscopic study of swallowing （ VFSS）.Results The prevalence rate of sialorrhea in PD was 59.5% （69/116, 95% CI 50.6%-68.4%）.Males were more likely to develop sialorrhea than females （47/70 vs 22/46,χ2 =4.298, P=0.038）.PD patients′sialorrhea correlated with oral dysphagia：with food leaking from the mouth （ liquid r=0.229, P=0.014; juice r=0.197, P=0.034;pudding viscosities r=0.231, P=0.013;solid food r=0.255, P=0.006）, with more than 1 ml of oral food residues （liquid r=0.319, P〈0.01;solid food r=0.185, P=0.047）, with delay in food transfer to the root of the tongue （liquid r=0.279, P=0.002; juice r=0.209, P=0.024）, and delayed swallow transfer （ pudding viscosities r=0.257, P=0.005）.Sialorrhea score was not related to H＆amp;Y stage, clinical course and levodopa equivalent doses （LED）.The prevalence rate of dysphagia in PD was 87.1%（95% CI 81.0% -93.2%）.Liquid was more likely to cause pharyngeal dysphagia （ P=0.03）.With the increase in H＆amp;Y stage , so did the oral and pharyngeal stages of dysphagia.Late and mid-course was more likely to develop oral and pharyngeal dysphagia than those with early clinical course .Conclusions Sialorrhea and dysphagia are common non-motor symptoms in PD patients.Sialorrhea is more prevalent in males and correlates with oral phase of dysphagia.Liquid is more likely to cause pharyngeal dysphagia.With increase in H＆amp;Y stage , so did oral and pharyngeal dysphagia.Even though late c

关 键 词：帕金森病 流涎 吞咽困难 电视X线透视吞咽功能检查 

分 类 号：R742.5[医药卫生—神经病学与精神病学]