帕金森病构音障碍声学特点的初步探索  

Study of voice disorder based on acoustic assessment in Parkinson ′s disease

作　　者：沈珺 张天宇[1] 黄菲菲[2] 周红[2] 滕飞 Kim Hakyung[3] 靳令经 Shen Jun;Zhang Tianyu;Huang Feifei;Zhou Hong;Teng Fei;Jin Lingjing(Department of Neurology,Tongji Hospital Affiliated to Tongji University,Shanghai 200065,China;Department of Neurology,Ninth People′s Hospital Affiliated to Medical College of Shanghai Jiaotong University,Shanghai 200011,China;Department of Education and Rehabilitation,Department of Education,East China Normal University,Shanghai 200062,China)

机构地区：[1]同济大学附属同济医院神经内科,上海200065 [2]上海交通大学医学院附属第九人民医院神经内科,200011 [3]华东师范大学教育学部教育康复学系,上海200062

出　　处：《中华神经科杂志》2019年第8期613-619,共7页Chinese Journal of Neurology

基　　金：国家重点研发计划资助项目(2018YFC1314700);国家自然科学基金资助项目(81572234);上海市市级医疗卫生优秀学科带头人培养计划资助项目(2017BR029).

摘　　要：目的分析帕金森病患者的声学特征,探索声学参数与病情和病程之间的相关性。方法选择2015年8—12月在同济大学附属同济医院和上海交通大学医学院附属第九人民医院诊断为帕金森病的患者52例作为病例组,并选择同期在两所医院进行健康体检的年龄相匹配的健康人32名作为对照。入组后,对帕金森病患者给予统一帕金森病评定量表(UPDRS)、Hoehn-Yahr(H-Y)分级评定量表评估,对帕金森病组和对照组均同时给予简易精神状态检查(MMSE)、声音障碍指数(Voice Handicap Index,VHI)的评估。采集所有研究对象的声音样本,使用嗓音功能检测仪分析频率微扰、振幅微扰、谐噪比值,使用实时言语测量仪分析基频、基频标准差和共振峰比值(F2i/F2u)。比较两组研究对象的声学参数特征,并分析帕金森病患者声学参数特征与病情和病程的相关性。结果帕金森病组52例中共有24例(46%)VHI异常,其中男性13例(54%),女性11例(46%)。与对照组[女性/a/1.43(1.19, 1.92)、/i/3.39(1.49,9.85)、/u/1.46(1.23,3.85),男性/a/1.06(0.92, 1.89)、/u/1.30(1.07,1.64)]比较,帕金森病组女性患者3个元音基频标准差[/a/2.99(1.81,4.12),Z=5.429,P<0.01;/i/10.89(5.47,22.20),Z=8.487,P<0.01;/u/5.16(3.75,7.80),Z=7.138,P<0.01]和男性患者的元音/a/、/u/的基频标准差[/a/2.16(1.73,2.94),Z=4.858,P=0.002;/u/3.70(2.41, 5.43),Z=7.664,P<0.01]均显著升高。帕金森病组的F2i/F2u(男性1.96±0.84,女性1.81±1.14)较对照组(男性3.48±0.70,女性4.14±1.08)均降低,差异均具有统计学意义(t=-6.669、-6.844,均P<0.01)。频率微扰、振幅微扰、谐噪比、基频两组间差异均无统计学意义。研究采用的声音参数中只有基频标准差与帕金森病患者病程有相关性。以H-Y分级评定疾病严重程度后,频率微扰值和振幅微扰值在中晚期患者均高于早期患者,频率微扰在3个元音中的差异均有统计学意义,振幅微扰在元音/i/、/u/中的差异�Objective To analyze the acoustic features of patients with Parkinson′s disease (PD), and to explore the correlation between the acoustic features and the severity and course of disease. Methods Fifty-two patients with PD from the Tongji Hospital Affiliated to Tongji Medical University and the Ninth People′s Hospital Affiliated to the Medical College of Shanghai Jiaotong University from August to December 2015 were enrolled into this study. Thirty-two age-matched healthy people served as control group. PD patients were tested with Unified Parkinson′s Disease Rating Scale (UPDRS) and Hoehn-Yahr (H-Y) staging. And all the patients were tested with Mini-Mental State Examiantion (MMSE) and Voice Handicap Index (VHI). The voice samples of all subjects were collected and the frequency perturbation (jitter), amplitude perturbation (shimmer), and harmonic-to-noise ratio (NHR) were analyzed using a vocal assessment. Fundamental frequency (F0), standard deviation of fundamental frequency (SDF0) and formant ratio (F2i/F2u) were analyzed using a real-time speech measuring instrument. The acoustic parameters of the two groups were compared and the correlation between the parameters of the patients and the disease and course of disease was analyzed. Results Subjective assessment using VHI showed a total of 24 VHI abnormalities (46%) in the PD group, including 13 males (54%), 11 females (46%). No VHI abnormalities were found in the control group. Among the parameters analyzed by objective acoustic method, compared with the control group (female/a/1.43(1.19, 1.92),/i/3.39(1.49,9.85),/u/1.46(1.23,3.85);male/a/1.06 (0.92, 1.89),/u/1.30(1.07,1.64)), the SDF0 of the three vowels of the female patients in the PD group (/a/2.99(1.81, 4.12), Z=5.429, P<0.01;/i/10.89(5.47, 22.20), Z=8.487, P<0.01;/u/5.16(3.75, 7.80), Z=7.138, P<0.01) and /a/and/u/of the male patients in the PD group (/a/2.16 (1.73, 2.94), Z=4.858, P=0.002;/u/3.70(2.41, 5.43), Z=7.664, P<0.01) were significantly increased, and the F2i/F2u in the PD group (male 1.96

关 键 词：帕金森病 发音障碍 言语声学 

分 类 号：R742.5[医药卫生—神经病学与精神病学]