嗓音障碍对早中期帕金森病患者生活质量的影响

Effect of voice handicap on quality of life in patients with Parkinson disease

目的 探讨嗓音障碍对早中期帕金森病(PD)患者生活质量的影响。方法 纳入2020年4月至2021年8月在首都医科大学附属北京康复医院帕金森病医学中心住院的86例早中期PD患者作为PD组,选取2021年12月至2022年2月从社会招募的47名健康人作为对照组,收集受试者的一般资料。采用Hoehn&Yahr(H&Y)分期确定PD患者的临床分级,采用国际运动障碍学会统一帕金森病评定量表第Ⅲ部分(MDS-UPDRS-Ⅲ)对PD患者的运动症状进行评估,采用39项帕金森病调查问卷(PDQ-39)、老年抑郁量表(GDS)、汉密尔顿焦虑量表(HAMA)、蒙特利尔认知评估量表(MoCA)、吞咽障碍问卷(SDQ)、嗓音障碍指数(VHI-10)对受试者的生活质量、抑郁、焦虑、认知功能、吞咽功能、嗓音状态进行评估。采用协方差分析比较两组VHI-10、PDQ-39得分。采用Spearman相关分析早中期PD患者嗓音障碍和生活质量的相关因素。采用多重线性回归分析早中期PD患者生活质量的影响因素。结果 协方差分析结果显示,PD组VHI-10、PDQ-39得分高于对照组[8.0(4.0,11.3)分比0(0,0)分、23.4(15.4,29.0)分比0(0,3.0)分],差异有统计学意义(P<0.01)。男性PD患者的PDQ-39得分低于女性患者[21.2(14.7,26.2)分比26.3(18.6,31.4)分],差异有统计学意义(Z=-2.41,P<0.05)。Spearman相关分析显示,PD患者的VHI-10得分与年龄、HAMA得分、GDS得分、SDQ得分呈正相关(r=0.25、0.31、0.42、0.64;P<0.05);PDQ-39得分与H&Y分期、UPDRS-Ⅲ得分、GDS得分、HAMA得分、SDQ得分、VHI-10得分呈正相关(r=0.22、0.24、0.54、0.37、0.33、0.47;P<0.05)。多重线性回归分析显示,GDS得分、VHI-10得分及性别是早中期PD患者生活质量的影响因素(P<0.01)。结论 早中期PD患者存在嗓音障碍问题,且嗓音障碍会降低早中期PD患者的生活质量。

Objective To investigate the effect of voice handicap on quality of life in patients with Parkinson disease(PD). Methods A total of 86 early and middle stage PD patients hospitalized in the Parkinson’s Medical Center of Beijing Rehabilitation Hospital affiliated to Capital Medical University from April 2020 to August 2021 were selected as PD group, and 47 healthy controls recruited from society from December 2021 to February 2022 were selected. General data of the subjects were collected. The clinical classification of PD patients was determined by Hoehn & Yahr(H&Y) staging. The motor symptoms of PD patients were evaluated by the International Association of Motion Disorders Unified Parkinson’s Disease Rating Scale Part Ⅲ (MDS-UPDRS-Ⅲ). The quality of life, depression, anxiety, cognitive function, swallowing function and voice status of the subjects were evaluated with 39 items of Parkinson’s Disease Questionnaire(PDQ-39), Geriatric Depression Scale( GDS), Hamilton Anxiety Scale( HAMA), Montreal Cognitive Assessment Scale( MoCA), Swallowing Disorder Questionnaire( SDQ) and Voice Handicap Index( VHI-10). The scores of VHI-10 and PDQ-39 in the two groups were compared by covariance analysis. Spearman correlation was used to analyze the related factors of voice handicap and quality of life in early and middle stage PD patients. Results The results of covariance analysis showed that the scores of VHI-10 and PDQ-39 in PD group were higher than those in control group[ 8.0(4.0,11.3) vs 0(0,0);23.4(15.4,29.0) vs 0(0,3.0)]. The difference was statistically significant( P< 0.01). The PDQ-39 score of male PD patients was lower than that of female atients[ 21.2(14.7,26.2) vs 26.3(18.6,31.4)], and the difference was statistically significan(tZ=-2.41,P<0.05). Spearman correlation analysis showed that the VHI-10 score of PD patients was positively correlated with age, HAMA score, GDS score and SDQ score( r=0.25,0.31,0.42,0.64;P < 0.05);PDQ-39 score was positively correlated with H&Y stage, UPDRS-Ⅲ score, GDS score, HAMA score, SDQ score and VHI-10 score( r=0.22,0.24,0.54,0.37,0.33,0.47;P<0.05). Multiple linear regression analysis showed that GDS score, VHI-10 score and gender were the influencing factors of quality of life in patients with early and middle stage PD( P<0.01). Conclusions Early and middle stage PD patients have voice handicap, and voice handicap will reduce their quality of life.