帕金森病吞咽功能障碍研究进展

Research progress of swallowing dysfunction in Parkinson’s disease

吞咽障碍是帕金森病(PD)的常见症状,超过80%PD患者在病程中出现吞咽障碍。吞咽障碍降低生活质量,使服药复杂化,导致患者营养不良和吸入性肺炎,也是PD死亡的主要原因。由于其病理生理机制不明,致吞咽障碍的诊断不足而被严重低估,尤其在疾病早期阶段。疾病和吞咽障碍之间的因果关系仍未阐明,可能原因为PD患者的自我意识较低、临床医生和照料者未能发现吞咽的微妙变化。为防止患者因健康问题如吸入性肺炎或营养不良等产生严重的后果,并对其生活质量产生不良影响,及时处理吞咽障碍并与多学科团队密切合作至关重要。本文就PD相关性吞咽障碍的流行病学、病理生理学、诊断和治疗进行综述,可能对神经学家、言语治疗师和其他临床医生在日常工作中处理PD患者和相关吞咽困难有一定帮助。

Dysphagia is a common symptom of Parkinson’s disease(PD)and More than 80%of PD patients have dysphagia during the course of the disease.Dysphagia reduces the quality of life,complicates medication,leads to malnutrition and aspiration pneumonia,and is also the main cause of death in PD.The underdiagnosis of dysphagia as a result of its pathophysiological mechanism is not well understood and is severely underestimated,especially in the early stages of the disease.The causal relationship between the disease and dysphagia has not yet been found,possibly due to the low self-awareness of PD patients and the failure of clinicians and caregivers to detect subtle changes in swallowing.To prevent patients from having serious negative consequences from health problems such as aspiration pneumonia or malnutrition that adversely affect their quality of life,timely management of dysphagia and close collaboration within a multidisciplinary team are essential.This article reviews the epidemiology,pathophysiology,diagnosis,and treatment of PD-associated swallowing disorders,which may be helpful for neurologists,speech therapists,and other clinicians in their daily work dealing with PD patients and related swallowing difficulties.