帕金森综合征患者营养不良与吞咽困难相关

doi:10.16352/j.issn.1001-6325.2024.09.1274

基础医学与临床 ›› 2024, Vol. 44 ›› Issue (9): 1274-1278.doi: 10.16352/j.issn.1001-6325.2024.09.1274

帕金森综合征患者营养不良与吞咽困难相关

王瑞^1#, 付锦^1#, 李蕊¹, 张玉萍¹, 王含^2*, 刘燕萍^1*

中国医学科学院北京协和医学院北京协和医院1.临床营养科;2.神经内科,北京100730

收稿日期:2024-02-27 修回日期:2024-05-29 出版日期:2024-09-05 发布日期:2024-08-30
通讯作者: ^*liuyp1227@vip.sina.com; wanghanpumch@163.com
作者简介:^#对本文有相同贡献
基金资助:
国家自然科学基金(82171255)

Malnutrition is associated with dysphagia in patients with Parkinsonism

WANG Rui^1#, FU Jin^1#, LI Rui¹, ZHANG Yuping¹, WANG Han^2*, LIU Yanping^1*

1. Department of Clinical Nutrition; 2. Department of Neurology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China

Received:2024-02-27 Revised:2024-05-29 Online:2024-09-05 Published:2024-08-30
Contact: ^*liuyp1227@vip.sina.com; wanghanpumch@163.com

摘要/Abstract

摘要： 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。

关键词: 帕金森综合征, 多学科联合会诊, 营养状况, 吞咽困难

Abstract: 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.

Key words: Parkinsonism, multi-disciplinary team, nutritional status, dysphagia

中图分类号:

R151

王瑞, 付锦, 李蕊, 张玉萍, 王含, 刘燕萍. 帕金森综合征患者营养不良与吞咽困难相关[J]. 基础医学与临床, 2024, 44(9): 1274-1278.

WANG Rui, FU Jin, LI Rui, ZHANG Yuping, WANG Han, LIU Yanping. Malnutrition is associated with dysphagia in patients with Parkinsonism[J]. Basic & Clinical Medicine, 2024, 44(9): 1274-1278.

参考文献 12

[1]	Li G, Ma J, Cui S, et al. Parkinson′s disease in China: a forty-year growing track of bedside work[J]. Transl Neurodegener, 2019, 8: 22. doi: 10.1186/s40035-019-0162-z.
[2]	Carne W, Cifu DX, Marcinko P, et al. Efficacy of multidisciplinary treatment program on long-term outcomes of individuals with Parkinson′s disease[J]. J Rehabil Res Dev, 2005, 42: 779-786.
[3]	National Collaborating Centre for Chronic C. National Institute for Health and Clinical Excellence: Guidance[M]. Parkinson′s Disease: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care. London; Royal College of Physicians (UK)Copyright© 2006, Royal College of Physicians of London. 2006.
[4]	Chen S, Chan P, Sun S, et al. The recommendations of Chinese Parkinson′s disease and movement disorder society consensus on therapeutic management of Parkinson′s disease[J]. Transl Neurodegener, 2016, 5: 12. doi: 10.1186/s40035-016-0059-z.
[5]	Bouça-Machado R, Pona-Ferreira F, Gonçalves N, et al. Outcome measures for evaluating the effect of a multidisciplinary intervention on axial symptoms of Parkinson′s disease[J]. Front Neurol, 2020, 11: 328. doi: 10.3389/fneur.2020.00328.
[6]	Rimmelzwaan LM, van Schoor NM, Lips P, et al. Systematic review of the relationship between vitamin D and Parkinson′s disease[J]. J Parkinsons Dis, 2016, 6: 29-37.
[7]	He M, Lian T, Guo P, et al. Association between nutritional status and gait performance in Alzheimer′s disease[J]. CNS Neurosci Ther, 2023. doi: 10.1111/cns.14502.
[8]	Quan Y, Xu J, Xu Q, et al. Association between the risk and severity of Parkinson′s disease and plasma homocysteine, vitamin B12 and folate levels: a systematic review and Meta-analysis[J]. Front Aging Neurosci, 2023, 15: 1254824. doi: 10.3389/fnagi.2023.1254824.
[9]	Bouillanne O, Morineau G, Dupont C, et al. Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients[J]. Am J Clin Nutr, 2005, 82: 777-783.
[10]	Frowen JJ, Cotton SM, Perry AR. The stability, reliabi-lity, and validity of videofluoroscopy measures for patients with head and neck cancer[J]. Dysphagia, 2008, 23: 348-363.
[11]	Zhou Z, Zhou R, Zhang Z, et al. The association between vitamin D status, vitamin D supplementation, sunlight exposure, and Parkinson′s disease: a systematic review and Meta-analysis[J]. Med Sci Monit, 2019, 25: 666-674.
[12]	Umemoto G, Furuya H. Management of dysphagia in patients with Parkinson′s disease and related disorders[J]. Intern Med, 2020, 59: 7-14.

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

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献 12

相关文章 1

编辑推荐

Metrics

本文评价