帕金森综合征患者营养不良与吞咽困难相关

Malnutrition is associated with dysphagia in patients with Parkinsonism

目的明确参与多学科联合会诊(MDT)的帕金森综合征患者的营养问题特征、营养状况与吞咽困难之间的相关性,并比较电视透视吞咽功能检查(VFSS)与EAT-10量表两种吞咽困难评估方法对营养不良的预测价值。方法研究对象为2020年11月至2023年1月参与北京协和医院MDT的帕金森综合征患者。使用EAT-10量表评分与VFSS吞咽困难评分,分别评价主观和客观吞咽困难;使用老年人营养风险指数(GNRI)、白蛋白、前白蛋白、血清叶酸、维生素B12及颞肌厚度等营养指标评价患者的营养状况。结果共30例研究对象符合纳入标准,年龄45~82(66.1±9.0)岁。使用GNRI进行综合营养状况评价,有6例(20%)存在营养不良风险。VFSS吞咽困难评分和EAT-10评分预测营养不良的接受者操作特征(ROC)曲线下面积(AUC)分别为0.736(0.497~0.975)和0.927(0.827~1.000)。EAT-10评分与GNRI(r=-0.524,P<0.01)、BMI(r=-0.618,P<0.001)、前白蛋白(r=-0.616,P<0.001)存在相关;而VFSS吞咽困难评分仅与BMI(r=-0.446,P<0.05)和前白蛋白(r=-0.387,P<0.05)之间存在相关性。结论需要MDT的帕金森综合征患者往往存在多种微量营养素失衡。与吞咽困难的客观评估相比,患者吞咽困难的主观感受对其营养状况的影响更大。

Objective To identify the characteristics of nutritional problems in patients with Parkinsonism who participated in multi-disciplinary team(MDT)and to investigate the correlation between nutritional status and dysphagia in these patients.The predictive value of video fluoroscopic swallowing study(VFSS)and EAT-10 scale for malnutrition was compared.Methods Subjects were patients with Parkinsonism participated in joint MDT consultation project in Peking Union Medical College Hospital from November 2020 to January 2023.Subjective and objective dysphagia were evaluated by EAT-10 scale score and VFSS dysphagia score.Nutritional status of the patients was evaluated by geriatric nutrition risk index(GNRI),albumin,prealbumin,serum folic acid,vitamin B12 and temporal muscle thickness.Results A total of 30 participants met the criteria and were included in the study.The age was 45-82(66.1±9.0)years old.Six(20%)were at risk of malnutrition shown b a comprehensive nutritional status assessment using GNRI.The areas under receiver operating characteristic(ROC)curves(AUC)of VFSS dysphagia score and EAT-10 score to predict malnutrition were 0.781(0.568-0.995)and 0.927(0.827-1.000),respectively.EAT-10 score was correlated with GNRI(r=-0.524,P<0.01),BMI(r=-0.618,P<0.001),prealbumin(r=-0.616,P<0.001).The VFSS dysphagia score was only correlated with BMI(r=-0.446,P<0.05)and prealbumin(r=-0.387,P<0.05).Conclusions Patients with Parkinsonism requiring MDT often have multiple micronutrient imbalance.Patients′subjective perception of dysphagia has a greater impact on their nutritional status than objective assessment of dysphagia.