才藤氏评级法对帕金森病患者吞咽功能筛查的意义及与长期营养状态的关系研究

Caiteng’s rating method in screening swallowing function of Parkinson’s disease and its correlation with long-term nutritional status of patients

目的探讨才藤氏评级法在帕金森病吞咽障碍筛查方面的灵敏度和特异度,及其与帕金森病患者长期营养状态的关系。方法选择2017年10月至2018年6月浙江中医药大学附属第二医院神经内科收治帕金森病患者61例,采用吞咽荧光透视造影检查(VFSS)分为吞咽正常组36例,吞咽障碍组25例,比较两组一般资料。分别行才藤氏评级法和洼田饮水试验进行吞咽功能筛查,并以VFSS为金标准,采用ROC曲线比较才藤氏评级法和洼田饮水试验筛查方法的灵敏度和特异度。利用多因子降维法(MDR)分析才藤氏评级法筛查的吞咽障碍与帕金森病患者长期营养状态的相关性,并探究与其他相关因素之间的交互作用。结果与吞咽正常组比较,吞咽障碍组的体重、BMI及简易营养评价精法(MNA-SF)评分均低于吞咽正常组,吞咽障碍组平均年龄、随访期间肺部感染发生率高于吞咽正常组,差异均有统计学意义(均P<0.05)。才藤氏评级法筛查帕金森病吞咽障碍的灵敏度(0.93)和特异度(0.91)均优于洼田饮水试验(灵敏度0.68,特异度0.86)。MDR分析结果提示才藤氏评级法评估的吞咽障碍、年龄及肺部感染均为影响帕金森病患者长期营养状态的重要因素,且3个因素之间存在明显的交互效应。结论帕金森病患者吞咽障碍发生率较高,才藤氏评级法可作为临床上筛查帕金森病吞咽障碍的有效手段,吞咽障碍、高龄及肺部感染3者之间交互作用明显,共同促使帕金森病患者长期营养状态恶化,才藤氏评级法可有效评估帕金森病预后。

Objective To screen the swallowing function of patients with Parkinson's disease(PD)with Caiteng’s rating method and to assess its correlation with long-termnutritional status of patients.Methods FromOctober 2017 to June 2018,61 patients with PD were enrolled in the study.Patients were divided into two groups:normal swallowing group(n=36)and dysphagia group(n=25),according to the results of video-fluoroscopic swallowing study(VFSS).Patients were screened for swallowing function by water swallow test and Caiteng’s rating method.Taking the VFSS as the gold standard,the ROC curve was used to assess the diagnostic value of two groups.The correlation of dysphagia screened by Caiteng’s rating method and other related factors with long-term nutritional status of PD patients was analyzed by multi-factor reduced-dimension(MDR)method.Results The body weight,BMI and MNA-SF scores of the dysphagia group were lower than those of the normal swallowing group.The average age and the incidence of pulmonary infection during the follow-up period in the dysphagia group were significantly higher than those in the normal swallowing group.The sensitivity and specificity of Caiteng’s rating method for screening dysphagia of PD were higher than those of water swallow test(0.93 vs.0.68,0.90 vs.0.86,P<0.05).The results of MDR analysis showed that age,dysphagia and pulmonary infection were important factors affecting the long-term nutritional status of PD patients,and there was a significant interaction among the three factors.Conclusion The incidence of dysphagia in PD patients is high.Caiteng’s rating method is effective for clinical screening of dysphagia in PD patients.There is a significant interaction among dysphagia,advanced age and pulmonary infection,which can jointly promote the deterioration of long-term nutritional status.